Healthcare Provider Details

I. General information

NPI: 1336287457
Provider Name (Legal Business Name): WEST FLORIDA MEDICAL ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10489 N FLORIDA AVE
CITRUS SPRINGS FL
34434-3268
US

IV. Provider business mailing address

PO BOX 640573
BEVERLY HILLS FL
34464-0573
US

V. Phone/Fax

Practice location:
  • Phone: 352-489-2486
  • Fax: 352-489-5786
Mailing address:
  • Phone: 352-746-1558
  • Fax: 352-746-3838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberME0071085
License Number StateFL

VIII. Authorized Official

Name: DR. ALEX VILLACASTIN
Title or Position: PHYSICIAN
Credential: MD
Phone: 352-489-2486