Healthcare Provider Details

I. General information

NPI: 1093864670
Provider Name (Legal Business Name): ALLERGY AND ASTHMA CARE OF THE PALM BEACHES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNIVERSITY BLVD 116
JUPITER FL
33458-2774
US

IV. Provider business mailing address

500 UNIVERSITY BLVD 116
JUPITER FL
33458-2774
US

V. Phone/Fax

Practice location:
  • Phone: 561-627-4377
  • Fax: 561-627-6496
Mailing address:
  • Phone: 561-627-4377
  • Fax: 561-627-6496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberME0060085
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH OTERO
Title or Position: OWNER
Credential: M.D.
Phone: 561-627-4377