| NPI | 1790066983 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TATIANA DE LA VEGA Office Manager 239-277-5877 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME101292) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME101292) |
| Enumeration Date | 2011-09-01 |
| Last Update Date | 2023-03-25 |