Healthcare Provider Details

I. General information

NPI: 1245403799
Provider Name (Legal Business Name): HEND ABDELMALEK PA MD FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4558 SAN JUAN AVE SUITE B
JACKSONVILLE FL
32210-2051
US

IV. Provider business mailing address

4558 SAN JUAN AVE SUITE B
JACKSONVILLE FL
32210-2051
US

V. Phone/Fax

Practice location:
  • Phone: 904-429-3000
  • Fax: 904-381-0543
Mailing address:
  • Phone: 904-429-3000
  • Fax: 904-381-0543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberME93970
License Number StateFL

VIII. Authorized Official

Name: MRS. HEND ABDELMALEK
Title or Position: PRESIDENT
Credential: MD
Phone: 904-429-3000