Healthcare Provider Details

I. General information

NPI: 1548258700
Provider Name (Legal Business Name): SEKINE RASNER BROCK MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 03/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11945 SAN JOSE BLVD STE 400
JACKSONVILLE FL
32223-1627
US

IV. Provider business mailing address

PO BOX 17399
JACKSONVILLE FL
32245-7399
US

V. Phone/Fax

Practice location:
  • Phone: 904-262-5333
  • Fax: 904-262-5337
Mailing address:
  • Phone: 904-262-5333
  • Fax: 904-262-5337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JUDITH HANNAH LENTO
Title or Position: PRACTICE ADMINISTRATOR
Credential: B.S.H., C.M.P.E.
Phone: 904-262-5333