Provider Demographics
NPI:1497100820
Name:IMBARLINA, ANTONIO JR (DO)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:IMBARLINA
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W GORE ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1044
Mailing Address - Country:US
Mailing Address - Phone:321-842-6671
Mailing Address - Fax:321-843-6521
Practice Address - Street 1:100 W GORE ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1044
Practice Address - Country:US
Practice Address - Phone:321-842-6671
Practice Address - Fax:321-843-6521
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS022094208100000X
FLOS215592081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL124674900Medicaid