Provider Demographics
NPI:1649677592
Name:ELITE CARE OF CENTRAL FLORIDA PLLC
Entity type:Organization
Organization Name:ELITE CARE OF CENTRAL FLORIDA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-875-0232
Mailing Address - Street 1:410 LIONEL WAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-7803
Mailing Address - Country:US
Mailing Address - Phone:863-216-5609
Mailing Address - Fax:863-808-0362
Practice Address - Street 1:410 LIONEL WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-7803
Practice Address - Country:US
Practice Address - Phone:863-216-5609
Practice Address - Fax:863-808-0362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty