Provider Demographics
NPI:1699004523
Name:INTERNAL MEDICINE & NEPHROLOGY, P.A.
Entity Type:Organization
Organization Name:INTERNAL MEDICINE & NEPHROLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:GUILLERMO
Authorized Official - Last Name:MOROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-282-4411
Mailing Address - Street 1:1400 N SEMORAN BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3564
Mailing Address - Country:US
Mailing Address - Phone:407-282-2441
Mailing Address - Fax:407-384-3005
Practice Address - Street 1:1400 N SEMORAN BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3564
Practice Address - Country:US
Practice Address - Phone:407-282-2441
Practice Address - Fax:407-384-3005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL51445261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty