Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 261815 | NY |
N | 111NI0900X | Internist | 261815 | NY |
Y | 207R00000X | Internist | ME130600 | FL |
Y | 111NI0900X | Internist | ME130600 | FL |
N | 207RG0300X | Geriatric Medicine | 261815 | NY |
N | 207RH0002X | Hospice and Palliative Medicine | 261815 | NY |
NPI | 1053542878 |
---|---|
Provider Name | Dr. Charlene Oris Recto |
First Address | Lakeland, FL 33805-3019 |
Second Address | Lakeland, FL 33813-3825 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2009 |
Last Update Date | 08/10/2020 |