Provider Demographics
NPI:1598226797
Name:PHOENIX MEDICAL CENTERS CORP
Entity Type:Organization
Organization Name:PHOENIX MEDICAL CENTERS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARNALDO
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:ORELLANA MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-273-2797
Mailing Address - Street 1:3645 W WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2783
Mailing Address - Country:US
Mailing Address - Phone:813-462-2595
Mailing Address - Fax:813-462-2596
Practice Address - Street 1:3645 W WATERS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2783
Practice Address - Country:US
Practice Address - Phone:813-462-2595
Practice Address - Fax:813-462-2596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-29
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty