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General NPI Number Information
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NPI Number | 1225451560
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Entity Type | Organization
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Legal Business Name | EL PALMAR LLC
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Dates
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Enumeration Date | 01/22/2014
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Last Update Date | 01/22/2014
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Provider Practice Location Address
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Address Line | 3406 W CARACAS ST
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City | TAMPA
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State | FL
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Zip | 33614-6604
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Country | US
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Telephone | 813-784-0328
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Fax | 813-405-8012
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Provider Business Mailing Address
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Address Line | 3406 W CARACAS ST
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City | TAMPA
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State | FL
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Zip | 33614-6604
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Country | US
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Telephone | 813-784-0328
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Fax | 813-405-8012
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Authorized Official
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Title or Position | OWNER
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Name | MR. DAGOBERTO MEDINA
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Credential |
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Telephone | 813-784-0328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | AL12080
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License Number State | FL
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