Provider Demographics
NPI:1376799593
Name:CHILDREN'S HEALTHCARE OF CENTRAL FLORIDA, LLC
Entity Type:Organization
Organization Name:CHILDREN'S HEALTHCARE OF CENTRAL FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:DUMALAOG-WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-716-5521
Mailing Address - Street 1:2105 HARTWOOD MARSH RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5389
Mailing Address - Country:US
Mailing Address - Phone:352-404-9200
Mailing Address - Fax:352-404-9232
Practice Address - Street 1:2105 HARTWOOD MARSH RD
Practice Address - Street 2:SUITE 9
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5389
Practice Address - Country:US
Practice Address - Phone:352-404-9200
Practice Address - Fax:352-404-9232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77853261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care