Healthcare Provider Details

I. General information

NPI: 1053602813
Provider Name (Legal Business Name): GLOBAL HEALTH RECORDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 OLD MOULTRIE RD
ST AUGUSTINE FL
32084-4168
US

IV. Provider business mailing address

604 KETTNER CT
ST AUGUSTINE FL
32086-6823
US

V. Phone/Fax

Practice location:
  • Phone: 904-794-7830
  • Fax: 904-794-6940
Mailing address:
  • Phone: 904-794-7830
  • Fax: 904-794-6940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberACN362
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN336
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberACN336
License Number StateFL

VIII. Authorized Official

Name: JOSE ANTONIO DELGADO
Title or Position: PRESIDENT
Credential:
Phone: 904-794-7830