Provider Demographics
NPI:1912938598
Name:ORLANDO COSMETIC SURGERY LLC DBA ALTIORA PLASTIC SURGERY & MED SPA
Entity Type:Organization
Organization Name:ORLANDO COSMETIC SURGERY LLC DBA ALTIORA PLASTIC SURGERY & MED SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CICILIONI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:941-388-1110
Mailing Address - Street 1:PO BOX 8670
Mailing Address - Street 2:
Mailing Address - City:LONGBOAT KEY
Mailing Address - State:FL
Mailing Address - Zip Code:34228
Mailing Address - Country:US
Mailing Address - Phone:941-388-1110
Mailing Address - Fax:941-388-1119
Practice Address - Street 1:2501 N ORANGE AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4603
Practice Address - Country:US
Practice Address - Phone:407-681-3223
Practice Address - Fax:407-681-0976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065746261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6083Medicare PIN