Provider Demographics
NPI:1144697350
Name:FAMILY HEALTH CLINIC OF ORLANDO, LLC
Entity type:Organization
Organization Name:FAMILY HEALTH CLINIC OF ORLANDO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORINA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-512-5700
Mailing Address - Street 1:1800 W OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-3962
Mailing Address - Country:US
Mailing Address - Phone:407-512-5700
Mailing Address - Fax:800-752-1493
Practice Address - Street 1:11121 CAMDEN PARK DR
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-5636
Practice Address - Country:US
Practice Address - Phone:407-668-1338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty