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General NPI Number Information
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NPI Number | 1104769348
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Entity Type | Organization
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Legal Business Name | ORTHOMETABOLIC PLLC
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Dates
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Enumeration Date | 04/13/2026
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Last Update Date | 04/13/2026
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Provider Practice Location Address
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Address Line | 1905 CLINT MOORE RD STE 300
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City | BOCA RATON
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State | FL
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Zip | 33496-2661
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Country | US
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Telephone | 305-924-3965
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Fax |
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Provider Business Mailing Address
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Address Line | 5201 WATERFORD DISTRICT DR STE 800
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City | MIAMI
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State | FL
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Zip | 33126-7050
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOCELYN RAE IDEMA
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Credential | DO
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Telephone | 305-924-3965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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