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General NPI Number Information
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NPI Number | 1184531352
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Entity Type | Organization
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Legal Business Name | ORTHO VISITS LLC
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Dates
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Enumeration Date | 08/25/2026
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Last Update Date | 08/25/2026
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Provider Practice Location Address
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Address Line | 1750 TREE BLVD STE 5
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-5719
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Country | US
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Telephone | 904-342-0672
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Fax | 833-438-1287
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Provider Business Mailing Address
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Address Line | 57 WILLOW ISLAND PT
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32092-1982
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Country | US
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Telephone | 904-392-0842
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | JORGE ENRIQUE DE LA ROTTA
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Credential | LICENSED APRN
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Telephone | 904-377-2675
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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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