Provider Demographics
NPI:1053542878
Name:RECTO, CHARLENE ORIS (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:ORIS
Last Name:RECTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHARLENE
Other - Middle Name:CALUNSAG
Other - Last Name:ORIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1600 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3019
Mailing Address - Country:US
Mailing Address - Phone:863-680-7000
Mailing Address - Fax:866-264-8519
Practice Address - Street 1:2300 E COUNTY ROAD 540A
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3825
Practice Address - Country:US
Practice Address - Phone:863-680-7190
Practice Address - Fax:866-264-8519
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261815207R00000X, 207RG0300X, 207RH0002X
FLME130600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine