Organization
ANDRELICA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ORLY PENA-SANCHEZ MD (OWNER)
(772) 237-4719
Entity
Organization
Contact information
Practice address
10616 S FEDERAL HWY, PORT SAINT LUCIE, FL 34952-6401
(772) 237-4719
Mailing address
10616 S FEDERAL HWY, PORT SAINT LUCIE, FL 34952-6401
(772) 237-4719
(772) 237-4738
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ACN232
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000174900
—
FL
Enumeration date
07/23/2011
Last updated
07/23/2011
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