Individual
CHARLES KENJI MIYAMOTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1400 S ORANGE AVE, ORLANDO, FL 32806-2134
(321) 843-8010
(321) 843-6330
Mailing address
1400 S ORANGE AVE, ORLANDO, FL 32806-2134
(321) 843-8010
(321) 843-6330
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
PA9115276
FL
363AS0400X
Surgical Physician Assistant
PA9115276
FL
Other
Enumeration date
02/08/2018
Last updated
07/08/2024
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