| NPI | 1477043180 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOURDES CAROLINA CERON CANAS Owner 904-891-9498 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2018-05-17 |
| Last Update Date | 2019-04-12 |