Provider Demographics
NPI:1629240924
Name:TOTAL WOMAN HEALTH CARE PA
Entity Type:Organization
Organization Name:TOTAL WOMAN HEALTH CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WENDELLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-294-2994
Mailing Address - Street 1:885 SEDALIA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3164
Mailing Address - Country:US
Mailing Address - Phone:407-294-2994
Mailing Address - Fax:407-294-2882
Practice Address - Street 1:885 SEDALIA ST STE 100
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3164
Practice Address - Country:US
Practice Address - Phone:407-294-2994
Practice Address - Fax:407-294-2882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0457914000Medicaid
D55085Medicare UPIN
FL0457914000Medicaid