Healthcare Provider Details

I. General information

NPI: 1487194981
Provider Name (Legal Business Name): TRAVEL MEDICINE & INFECTIOUS DISEASES OF THE PALM BEACHES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 S CONGRESS AVE STE 201
ATLANTIS FL
33462-6637
US

IV. Provider business mailing address

10115 FOREST HILL BLVD SUITE 102
WELLINGTON FL
33414-3105
US

V. Phone/Fax

Practice location:
  • Phone: 561-967-0101
  • Fax: 561-967-6260
Mailing address:
  • Phone: 561-967-0101
  • Fax: 561-967-6260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME0094948
License Number StateFL

VIII. Authorized Official

Name: DIANE ESCOBEDO
Title or Position: OFFICE MANAGER
Credential:
Phone: 561-967-0101