NPIMap

Organization Active NPI

Nutmeg Holdings LLC

Doing business as Lake Baldwin Medical

  • Clinic/Center
  • Orlando, FL
National Provider Identifier
1619132867
Registry record updated Mar 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
NUTMEG HOLDINGS LLC
Doing business as
Lake Baldwin Medical
Practice address
1459 Lake Baldwin LN
Suite a
Orlando, FL 32814-6741
Phone
(407) 893-3905
Fax
(407) 893-3906
NPI assigned
Jul 26, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
S Rafik Bouaziz
Title
Manager / Director
Phone
(407) 893-3905

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

1459 Lake Baldwin LN
Suite a
Orlando, FL 32814-6741

Mailing address

PO Box 149374
Orlando, FL 32814-9374
Phone (407) 893-3905

Other names 1

  • LAKE BALDWIN MEDICAL Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1217030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331251200000",
    "number": "1619132867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 149374",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328149374",
            "telephone_number": "407-893-3905",
            "fax_number": "407-893-3906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1459 LAKE BALDWIN LN",
            "address_2": "SUITE A",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328146741",
            "telephone_number": "407-893-3905",
            "fax_number": "407-893-3906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NUTMEG HOLDINGS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-26",
        "last_updated": "2012-03-09",
        "status": "A",
        "authorized_official_last_name": "BOUAZIZ",
        "authorized_official_first_name": "S",
        "authorized_official_middle_name": "RAFIK",
        "authorized_official_title_or_position": "MANAGER / DIRECTOR",
        "authorized_official_telephone_number": "407-893-3905"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LAKE BALDWIN MEDICAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.