Organization
CENTRAL FLORIDA CANCER INSTITUTE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE MARTINEZ (CFO)
(407) 566-9899
Entity
Organization
Contact information
Practice address
2 STATE ROAD 60 W, LAKE WALES, FL 33853-4118
(863) 679-2960
(863) 679-2781
Mailing address
1420 CELEBRATION BLVD, 308, CELEBRATION, FL 34747-5159
(407) 566-9899
(407) 566-9893
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
ME51222
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
263977700
—
FL
Enumeration date
02/05/2013
Last updated
04/18/2014
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