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General NPI Number Information
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NPI Number | 1225235880
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Entity Type | Organization
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Legal Business Name | US BARIATRIC ST AUGUSTINE LLC
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 300 HEALTH PARK BLVD 5002
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-3707
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Country | US
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Telephone | 904-819-5861
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Fax |
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Provider Business Mailing Address
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Address Line | 300 HEALTH PARK BLVD 5002
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City | ST. AUGUSTINE
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State | FL
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Zip | 32086
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Country | US
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Telephone | 904-819-5861
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. ROBERT MAREMA
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Credential |
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Telephone | 904-819-5861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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