MEDICARE: PEDIATRIC URGENT CARE GROUP OF ORMOND BEACH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1972318491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC URGENT CARE GROUP OF ORMOND BEACH

Provider Business Mailing Address
First Line	:	1688 W GRANADA BLVD STE 1A
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-1818
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1688 W GRANADA BLVD STE 1A
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-1818
Country	:	US
Telephone Number	:	386-316-6276
Fax Number	:	386-221-3503

Authorized Official
Title or Position	:	MD, OWNER
Name	:	JAIME E QUINTEROS
Credential	:
Telephone Number	:	386-425-4414

Provider Enumeration Date	:	02/11/2025
Last Update Date	:	02/06/2026

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