Healthcare Provider Details

I. General information

NPI: 1225235880
Provider Name (Legal Business Name): US BARIATRIC ST AUGUSTINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HEALTH PARK BLVD 5002
ST AUGUSTINE FL
32086-3707
US

IV. Provider business mailing address

300 HEALTH PARK BLVD 5002
ST. AUGUSTINE FL
32086
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-5861
  • Fax:
Mailing address:
  • Phone: 904-819-5861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT MAREMA
Title or Position: CEO
Credential:
Phone: 904-819-5861