Provider Demographics
NPI:1184806127
Name:MUGUERCIA, KARELINA
Entity type:Individual
Prefix:
First Name:KARELINA
Middle Name:
Last Name:MUGUERCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 W KALEY ST STE 300B
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2940
Mailing Address - Country:US
Mailing Address - Phone:407-872-8491
Mailing Address - Fax:407-872-2454
Practice Address - Street 1:25 W KALEY ST STE 300B
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2940
Practice Address - Country:US
Practice Address - Phone:407-872-8491
Practice Address - Fax:407-872-2454
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-01
Last Update Date:2012-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBA561WMedicare PIN