Provider Demographics
NPI:1184445124
Name:MIGRAINE AND HEADACHE CENTER OF FLORIDA, LLC
Entity type:Organization
Organization Name:MIGRAINE AND HEADACHE CENTER OF FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZARIO-LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-960-1067
Mailing Address - Street 1:PO BOX 940065
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32794-0065
Mailing Address - Country:US
Mailing Address - Phone:407-960-1067
Mailing Address - Fax:407-960-1076
Practice Address - Street 1:249 MAITLAND AVE STE 3100
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4906
Practice Address - Country:US
Practice Address - Phone:407-960-1067
Practice Address - Fax:407-960-1076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-22
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty