Healthcare Provider Details

I. General information

NPI: 1326342585
Provider Name (Legal Business Name): AMERINET HEALTH CENTER SOUTH DAYTONA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 BEVILLE RD
SOUTH DAYTONA FL
32119-1935
US

IV. Provider business mailing address

619 BEVILLE RD
SOUTH DAYTONA FL
32119-1935
US

V. Phone/Fax

Practice location:
  • Phone: 702-287-8602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberOS5974
License Number StateFL

VIII. Authorized Official

Name: MR. BRYAN PRESTON CAUDILL
Title or Position: PARTNER
Credential:
Phone: 702-287-8602