Healthcare Provider Details

I. General information

NPI: 1205095858
Provider Name (Legal Business Name): BEATRIZ L PAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2008
Last Update Date: 06/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10120 LAKE VIEW RD W
JACKSONVILLE FL
32225-4436
US

IV. Provider business mailing address

10120 LAKE VIEW RD W
JACKSONVILLE FL
32225-4436
US

V. Phone/Fax

Practice location:
  • Phone: 904-642-0335
  • Fax:
Mailing address:
  • Phone: 904-642-0335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number6905876
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: