Organization
ORLANDO IMMUNOLOGY CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWIN DEJESUS MD (OWNER)
(407) 647-3960
Entity
Organization
Contact information
Practice address
1707 N MILLS AVE, ORLANDO, FL 32803-1851
(407) 647-3960
(407) 413-5775
Mailing address
1707 N MILLS AVE, ORLANDO, FL 32803-1851
(407) 647-3960
(407) 413-5775
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104671400
—
FL
Enumeration date
09/27/2019
Last updated
05/08/2024
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