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General NPI Number Information
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NPI Number | 1063039303
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Entity Type | Organization
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Legal Business Name | PRIMARY HEALTHCARE ALLIANCE FOUNDATION INC
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Dates
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Enumeration Date | 07/02/2020
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Last Update Date | 07/02/2020
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Provider Practice Location Address
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Address Line | 1445 DUNN AVE STE B
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-1437
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Country | US
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Telephone | 386-238-9527
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Fax | 386-492-5059
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Provider Business Mailing Address
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Address Line | 1445 DUNN AVE STE B
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-1437
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Country | US
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Telephone | 386-238-9527
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Fax | 386-492-5059
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MARIA BAEZ
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Credential |
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Telephone | 386-238-9527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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