Healthcare Provider Details

I. General information

NPI: 1447447339
Provider Name (Legal Business Name): PABLO M PELLA, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11555 CENTRAL PKWY STE 201
JACKSONVILLE FL
32224-2693
US

IV. Provider business mailing address

11555 CENTRAL PKWY STE 201
JACKSONVILLE FL
32224-2693
US

V. Phone/Fax

Practice location:
  • Phone: 904-646-3420
  • Fax: 904-646-3017
Mailing address:
  • Phone: 904-646-3420
  • Fax: 904-646-3017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0064398
License Number StateFL

VIII. Authorized Official

Name: MS. WENDY C. LU
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 904-221-2535