Healthcare Provider Details

I. General information

NPI: 1972318491
Provider Name (Legal Business Name): PEDIATRIC URGENT CARE GROUP OF ORMOND BEACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1688 W GRANADA BLVD STE 1B
ORMOND BEACH FL
32174-1818
US

IV. Provider business mailing address

1688 W GRANADA BLVD STE 1B
ORMOND BEACH FL
32174-1818
US

V. Phone/Fax

Practice location:
  • Phone: 386-425-4414
  • Fax: 386-221-3503
Mailing address:
  • Phone: 386-425-4414
  • Fax: 386-221-3503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAIME E QUINTEROS
Title or Position: PRESIDENT
Credential: MD
Phone: 386-425-4414