Provider Demographics
NPI:1376597765
Name:DE ORDUNA, CARLOS L (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:L
Last Name:DE ORDUNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33836-0878
Mailing Address - Country:US
Mailing Address - Phone:689-223-3898
Mailing Address - Fax:689-223-3898
Practice Address - Street 1:5979 VINELAND RD STE 206
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7855
Practice Address - Country:US
Practice Address - Phone:407-352-9300
Practice Address - Fax:407-351-6509
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69748207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250329800Medicaid
FL28947OtherBLUE CROSS BLUE SHIELD
FL28947OtherBLUE CROSS BLUE SHIELD
FL28947AMedicare ID - Type Unspecified