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General NPI Number Information
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NPI Number | 1245554799
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Entity Type | Organization
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Legal Business Name | DIABETICO INTERNACIONAL, INC.
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Dates
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Enumeration Date | 03/25/2010
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 2520 UNIVERSITY BLVD W
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2004
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Country | US
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Telephone | 904-914-8947
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Fax | 904-895-4729
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Provider Business Mailing Address
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Address Line | 2520 UNIVERSITY BLVD W
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2004
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Country | US
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Telephone | 904-914-8947
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Fax | 904-895-4729
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | LAVERN WEBSTER-DOWELL
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Credential | BSN,RN,CDE
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Telephone | 904-253-7967
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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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Taxonomy #2
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Taxonomy Code | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | 3300612
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License Number State | FL
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