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General NPI Number Information
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NPI Number | 1265765531
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Entity Type | Organization
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Legal Business Name | DAIRY ROAD URGENT CARE LLC
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Dates
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Enumeration Date | 09/17/2009
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Last Update Date | 04/23/2016
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Provider Practice Location Address
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Address Line | 2107 DAIRY RD
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City | MELBOURNE
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State | FL
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Zip | 32904-5209
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Country | US
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Telephone | 321-956-8224
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Fax | 321-956-8225
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Provider Business Mailing Address
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Address Line | PO BOX 120043
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City | WEST MELBOURNE
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State | FL
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Zip | 32912-0043
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Country | US
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Telephone | 321-956-8224
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Fax | 321-956-8225
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MIGUEL LYNN LORENTE
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Credential | MD
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Telephone | 321-956-8224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | ME82880
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License Number State | FL
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