Organization
PELICAN BEACH INC
Active
Other names
33rd Street Family Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VILMARY VAZQUEZ NCMA (HEALTHCARE ADMINISTRATOR)
(407) 648-0076
Entity
Organization
Contact information
Practice address
4382 LB MCLEOD RD, ORLANDO, FL 32811
(407) 648-0076
(407) 648-3666
Mailing address
4382 LB MCLEOD RD, ORLANDO, FL 32811
(407) 648-0076
(407) 648-3666
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DB888A
PTAN
—
Enumeration date
08/09/2006
Last updated
04/15/2014
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