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General NPI Number Information
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NPI Number | 1104218973
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Entity Type | Organization
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Legal Business Name | CARDIOHEALTH
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Dates
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Enumeration Date | 03/03/2015
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Last Update Date | 03/03/2015
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Provider Practice Location Address
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Address Line | 3599 UNIVERSITY BLVD S STE 104
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4200
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Country | US
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Telephone | 904-724-5000
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Fax | 904-677-4498
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Provider Business Mailing Address
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Address Line | 3599 UNIVERSITY BLVD S STE 104
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4200
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Country | US
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Telephone | 904-724-5000
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Fax | 904-677-4498
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Authorized Official
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Title or Position | FOUNDER/PHYSICIAN
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Name | RAMON CASTELLO
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Credential | M.D.
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Telephone | 904-724-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | ARNP9294077
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License Number State | FL
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