Individual
DR. CARLOS P GRULLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1745 N MILLS AVE STE 100, ORLANDO, FL 32803-4599
(407) 841-7151
(407) 425-2768
Mailing address
1745 N MILLS AVE STE 100, ORLANDO, FL 32803-4599
(407) 841-7151
(407) 425-2768
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
ME64646
FL
207UN0901X
Nuclear Cardiology Physician
ME64646
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23177
BLUE SHIELD OF FL
FL
Enumeration date
09/15/2006
Last updated
02/18/2025
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