Provider Demographics
NPI:1649884081
Name:RADIANCE CENTER FOR OBSTETRICS AND GYNECOLOGY LLC
Entity type:Organization
Organization Name:RADIANCE CENTER FOR OBSTETRICS AND GYNECOLOGY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATEYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-743-2100
Mailing Address - Street 1:1118 S ORANGE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1200
Mailing Address - Country:US
Mailing Address - Phone:407-743-2100
Mailing Address - Fax:407-743-2101
Practice Address - Street 1:1118 S ORANGE AVE STE 202
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1200
Practice Address - Country:US
Practice Address - Phone:407-743-2100
Practice Address - Fax:407-743-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty