Provider Demographics
NPI:1811732431
Name:ALDAMA GAROFALO, LIUVIT A
Entity type:Individual
Prefix:
First Name:LIUVIT
Middle Name:A
Last Name:ALDAMA GAROFALO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W COLONIAL DR STE 303
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6863
Mailing Address - Country:US
Mailing Address - Phone:407-956-1920
Mailing Address - Fax:407-271-4271
Practice Address - Street 1:920 N JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4914
Practice Address - Country:US
Practice Address - Phone:407-956-1920
Practice Address - Fax:407-271-8436
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11033644363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily