Provider Demographics
NPI:1205517430
Name:WINTER PARK UNIVERSITY CENTER MEDICAL LLC
Entity type:Organization
Organization Name:WINTER PARK UNIVERSITY CENTER MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GAMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:NEMATALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-356-1454
Mailing Address - Street 1:7053 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-6720
Mailing Address - Country:US
Mailing Address - Phone:321-356-1454
Mailing Address - Fax:877-714-9315
Practice Address - Street 1:7053 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-6720
Practice Address - Country:US
Practice Address - Phone:321-356-1454
Practice Address - Fax:877-714-9315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center