| Organization Name: | CHULUOTA CLINIC, LLC |
| NPI Number: | 1508119637 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL GEORGE PRUNER (OWNER) |
| Mailing Address: | 107 8th St W Chuluota |
| State: | FL US |
| Postal Code: | 327668924 |
| Phone Number: | 4075427961 |
| Fax Number: | |
| NPI Enumeration Date: | 10/26/2012 |
| NPI Last Update Date: | 10/26/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 182428 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |