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General NPI Number Information
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NPI Number | 1083831192
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Entity Type | Organization
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Legal Business Name | PEDIATRIC URGENT CARE GROUP OF ORMOND BEACH
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 11/17/2009
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Provider Practice Location Address
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Address Line | 1688 W GRANADA BLVD SUITE 1A
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City | ORMOND BEACH
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State | FL
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Zip | 32174-1851
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Country | US
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Telephone | 386-615-4414
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Fax | 386-615-8466
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Provider Business Mailing Address
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Address Line | 1688 W GRANADA BLVD SUITE 1A
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City | ORMOND BEACH
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State | FL
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Zip | 32174-1851
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Country | US
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Telephone | 386-615-4414
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Fax | 386-615-8466
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAIME E QUINTEROS
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Credential | MD
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Telephone | 386-615-4414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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