Healthcare Provider Details

I. General information

NPI: 1396375556
Provider Name (Legal Business Name): REGION MEDICAL CENTER, CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3375 PINE RIDGE RD UNIT 206A
NAPLES FL
34109-3925
US

IV. Provider business mailing address

3375 PINE RIDGE RD UNIT 206A
NAPLES FL
34109-3925
US

V. Phone/Fax

Practice location:
  • Phone: 239-438-1937
  • Fax: 239-631-5971
Mailing address:
  • Phone: 239-438-1937
  • Fax: 239-631-5971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ARIEL GONZALEZ
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 239-207-4802