Healthcare Provider Details

I. General information

NPI: 1184531352
Provider Name (Legal Business Name): ORTHO VISITS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 TREE BLVD STE 5
ST AUGUSTINE FL
32084-5719
US

IV. Provider business mailing address

57 WILLOW ISLAND PT
SAINT AUGUSTINE FL
32092-1982
US

V. Phone/Fax

Practice location:
  • Phone: 904-342-0672
  • Fax: 833-438-1287
Mailing address:
  • Phone: 904-392-0842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JORGE ENRIQUE DE LA ROTTA
Title or Position: OWNER/PROVIDER
Credential: LICENSED APRN
Phone: 904-377-2675