# ELITE OB-GYN SURGERY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Elite OB/GYN Surgery LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407655822
- **Authorized official:** MR. JOHNNY RIVERA JR. (ADMINISTRATOR)
- **Authorized official phone:** (407) 529-7752

## Contact information

- **Practice address:** 801 N ORANGE AVE STE 710, ORLANDO, FL 32801-5202
- **Practice address phone:** (407) 529-7752
- **Practice address fax:** (407) 459-7542
- **Mailing address:** 801 N ORANGE AVE STE 710, ORLANDO, FL 32801-5202
- **Mailing address phone:** (407) 529-7752
- **Mailing address fax:** (407) 459-7542

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 207VG0400X | Gynecology Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | — | — |
| 208600000X | Surgery Physician | — | — | — |
| 208800000X | Urology Physician | — | — | — |
| 363L00000X | Nurse Practitioner | — | — | Yes |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 03/10/2025
- **Last updated:** 03/10/2025