Healthcare Provider Details

I. General information

NPI: 1962807503
Provider Name (Legal Business Name): METRO PAVIA HEALTHCARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 HERON BAY RD
JACKSONVILLE FL
32218-3595
US

IV. Provider business mailing address

145 HERON BAY RD FL 2670
JACKSONVILLE FL
32218-3595
US

V. Phone/Fax

Practice location:
  • Phone: 904-470-6900
  • Fax:
Mailing address:
  • Phone: 904-470-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARIA LOPEZ
Title or Position: VP OPERACIONAL SENIOR
Credential:
Phone: 787-230-7530