Organization Name: | POINCIANA MEDICAL CLINIC |
NPI Number: | 1871923037 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | IVAN A RIVERA SOLER (MD) |
Mailing Address: | 51 N Doverplum Ave Kissimmee |
State: | FL US |
Postal Code: | 347583308 |
Phone Number: | 4075728862 |
Fax Number: | 4075728863 |
NPI Enumeration Date: | 11/25/2013 |
NPI Last Update Date: | 07/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | ACN241 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |