# MAXINE MINTO MD P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376828178
- **Authorized official:** DR. MAXINE JOAN MINTO M.D. (PRESIDENT)
- **Authorized official phone:** (407) 536-5375

## Contact information

- **Practice address:** 1540 INTERNATIONAL PKWY, SUITE 2000, LAKE MARY, FL 32746-4713
- **Practice address phone:** (407) 536-5375
- **Practice address fax:** (407) 536-5301
- **Mailing address:** 10524 MOSS PARK RD, SUITE 204-516, ORLANDO, FL 32832-5898
- **Mailing address phone:** (407) 536-5375
- **Mailing address fax:** (407) 536-5301

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0850X | Adult Mental Health Clinic/Center | ME69898 | FL | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | ME69898 | FL | Yes |

## Other

- **Enumeration date:** 10/12/2011
- **Last updated:** 10/13/2011