Provider Demographics
NPI:1982357992
Name:MID FLORIDA AUTISM CENTER
Entity Type:Organization
Organization Name:MID FLORIDA AUTISM CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-299-7333
Mailing Address - Street 1:7652 ASHLEY PARK CT STE 306
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6199
Mailing Address - Country:US
Mailing Address - Phone:407-299-7333
Mailing Address - Fax:407-293-2049
Practice Address - Street 1:25 WINDSORMERE WAY STE 101301
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6509
Practice Address - Country:US
Practice Address - Phone:407-299-7333
Practice Address - Fax:407-293-2049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty