Individual
ORLANDO MOGOLLON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SA-C
Contact information
Practice address
4560 WILLIAMSTOWN BLVD, LAKELAND, FL 33810-2738
(407) 535-0055
Mailing address
4560 WILLIAMSTOWN BLVD, LAKELAND, FL 33810-2738
(407) 535-0055
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
16-461
—
Other
Enumeration date
01/29/2020
Last updated
01/29/2020
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