Provider Demographics
NPI:1538198783
Name:CFA KIDNEY & HYPERTENSION CENTER LLC
Entity type:Organization
Organization Name:CFA KIDNEY & HYPERTENSION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUFUNMILOLA
Authorized Official - Middle Name:OLUWAKEMI
Authorized Official - Last Name:DARAMOLA-OGUNWUYI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-214-4133
Mailing Address - Street 1:P O BOX 915467
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32791-5467
Mailing Address - Country:US
Mailing Address - Phone:321-214-4133
Mailing Address - Fax:321-214-4216
Practice Address - Street 1:587 E STATE ROAD 434
Practice Address - Street 2:SUITE 1011
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5284
Practice Address - Country:US
Practice Address - Phone:321-214-4133
Practice Address - Fax:321-214-4216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL06000028969261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
14479901OtherCITRUS HEALTH CARE PLAN
7281278OtherCIGNA
FLDF1497OtherRAILROAD MEDICARE
FL56284OtherBLUE CROSS BLUE SHIELD
FL276132700Medicaid
303267OtherAVMED
FL354671OtherWELLCARE
14479901OtherCITRUS HEALTH CARE PLAN
7281278OtherCIGNA