Organization
PROGRESSIVE PEDIATRICS OF ORLANDO PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALFONSO MIRELES MD (OWNER)
(407) 830-5437
Entity
Organization
Contact information
Practice address
521 W STATE ROAD 434, SUITE 101, LONGWOOD, FL 32750
(407) 830-5437
(407) 834-4907
Mailing address
PO BOX 520879, LONGWOOD, FL 32752-0879
(407) 830-5437
(407) 834-4907
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME54968
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
272040000
—
FL
Enumeration date
07/12/2006
Last updated
05/14/2008
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