Provider Demographics
NPI:1790802395
Name:ORLANDO CARDIOVASCULAR INSTITUTE P A
Entity Type:Organization
Organization Name:ORLANDO CARDIOVASCULAR INSTITUTE P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARISEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARMONA-TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-228-7373
Mailing Address - Street 1:PO BOX 3749
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32802-3749
Mailing Address - Country:US
Mailing Address - Phone:407-228-7373
Mailing Address - Fax:407-228-7393
Practice Address - Street 1:2501 N ORANGE AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4603
Practice Address - Country:US
Practice Address - Phone:407-228-7373
Practice Address - Fax:407-228-7393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62668208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1712Medicare ID - Type UnspecifiedGROUP