Healthcare Provider Details

I. General information

NPI: 1457411373
Provider Name (Legal Business Name): REZ INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PLANTATION ISLAND DR S SUITE 402 B
ST AUGUSTINE FL
32080-3108
US

IV. Provider business mailing address

1301 PLANTATION ISLAND DR S SUITE 402 B
ST AUGUSTINE FL
32080-3108
US

V. Phone/Fax

Practice location:
  • Phone: 904-823-3777
  • Fax: 904-823-3363
Mailing address:
  • Phone: 904-823-3777
  • Fax: 904-823-3363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberME0057416
License Number StateFL

VIII. Authorized Official

Name: DR. REZWAN ROSA ASHDJI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 904-823-3777