Provider Demographics
NPI:1376836726
Name:PHYSICIAN'S CARE OF POINCIANA, LLC
Entity Type:Organization
Organization Name:PHYSICIAN'S CARE OF POINCIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:
Authorized Official - First Name:ELISEO
Authorized Official - Middle Name:D
Authorized Official - Last Name:ESPAILLAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-333-7856
Mailing Address - Street 1:3358 W SOUTHPORT RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-2706
Mailing Address - Country:US
Mailing Address - Phone:786-333-7856
Mailing Address - Fax:305-846-9389
Practice Address - Street 1:3358 W SOUTHPORT RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-2706
Practice Address - Country:US
Practice Address - Phone:786-333-7856
Practice Address - Fax:305-846-9389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME18355170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty