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General NPI Number Information
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NPI Number | 1063570364
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Entity Type | Organization
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Legal Business Name | FLORIDA MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 03/20/2020
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Provider Practice Location Address
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Address Line | 38101 MARKET SQ
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City | ZEPHYRHILLS
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State | FL
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Zip | 33542-7505
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Country | US
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Telephone | 813-782-5587
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Fax | 813-355-5049
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Provider Business Mailing Address
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Address Line | 38135 MARKET SQ
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City | ZEPHYRHILLS
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State | FL
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Zip | 33542-7505
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Country | US
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Telephone | 813-528-4975
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOE DELATORRE
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Credential |
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Telephone | 813-780-8440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | DO2350
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License Number State | FL
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