Provider Demographics
NPI:1023819778
Name:ATIENZA PHYSICIAN SERVICES LLC
Entity type:Organization
Organization Name:ATIENZA PHYSICIAN SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:TIA
Authorized Official - Last Name:ATIENZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-566-3292
Mailing Address - Street 1:405 MICKLETON LOOP
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-5661
Mailing Address - Country:US
Mailing Address - Phone:209-566-3292
Mailing Address - Fax:
Practice Address - Street 1:1820 E SILVER STAR RD
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-7016
Practice Address - Country:US
Practice Address - Phone:469-713-1145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty