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General NPI Number Information
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NPI Number | 1114605706
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Entity Type | Organization
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Legal Business Name | SOLACE MEDICAL CARE PB LLC
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Dates
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Enumeration Date | 07/05/2023
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 1890 PALM BAY RD NE STE 1
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City | PALM BAY
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State | FL
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Zip | 32905-3071
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Country | US
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Telephone | 407-593-2290
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Fax |
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Provider Business Mailing Address
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Address Line | 10524 MOSS PARK RD STE 204-750
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City | ORLANDO
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State | FL
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Zip | 32832-5898
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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 | CFO
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Name | JOS QUEZADA
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Credential |
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Telephone | 407-301-8116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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