Healthcare Provider Details

I. General information

NPI: 1467649632
Provider Name (Legal Business Name): QIXIA HUANG, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PLANTATION ISLAND DR S STE 102A
ST AUGUSTINE FL
32080-3109
US

IV. Provider business mailing address

1301 PLANTATION ISLAND DR S STE 102A
ST AUGUSTINE FL
32080-3109
US

V. Phone/Fax

Practice location:
  • Phone: 904-471-5626
  • Fax:
Mailing address:
  • Phone: 904-471-5626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberME78764
License Number StateFL

VIII. Authorized Official

Name: DR. QIXIA HUANG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 904-471-5626