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General NPI Number Information
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NPI Number | 1265816219
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Entity Type | Organization
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Legal Business Name | METCARE OF ORMOND BEACH
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Dates
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Enumeration Date | 07/18/2015
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 420 S NOVA RD SUITE 4&5
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City | ORMOND BEACH
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State | FL
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Zip | 32174-0410
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Country | US
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Telephone | 386-615-8122
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Fax | 386-615-8139
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Provider Business Mailing Address
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Address Line | 6101 BLUE LAGOON DR STE 200
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City | MIAMI
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State | FL
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Zip | 33126-3168
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Country | US
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Telephone | 305-500-2000
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Fax |
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Authorized Official
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Title or Position | ASSOCIATE DIRECTOR
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Name | JESSICA MARIE BONETTI
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Credential |
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Telephone | 305-500-2000
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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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