Organization
NUTMEG HOLDINGS LLC
Active
Other names
LAKE BALDWIN MEDICAL
Organization subpart
No
Provider details
NPI number
Authorized official
S RAFIK BOUAZIZ (MANAGER / DIRECTOR)
(407) 893-3905
Entity
Organization
Contact information
Practice address
1459 LAKE BALDWIN LN, SUITE A, ORLANDO, FL 32814-6741
(407) 893-3905
(407) 893-3906
Mailing address
PO BOX 149374, ORLANDO, FL 32814-9374
(407) 893-3905
(407) 893-3906
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
07/26/2008
Last updated
03/09/2012
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