Organization
COMMONHEALTH SERVICES CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLOS MANUEL DE LA CRUZ R.PH. (CEO)
(407) 275-1373
Entity
Organization
Contact information
Practice address
733 N 3RD ST, LEESBURG, FL 34748-4441
(352) 435-7214
(352) 435-7553
Mailing address
960 MAPLE FOREST DR, ORLANDO, FL 32825-6450
(407) 275-1373
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME69780
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
379673600
—
FL
Enumeration date
10/03/2016
Last updated
10/03/2016
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