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General NPI Number Information
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NPI Number | 1366607335
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Entity Type | Organization
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Legal Business Name | FAMILY CARE OF PALM COAST PA
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Dates
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Enumeration Date | 07/18/2008
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Last Update Date | 07/18/2008
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Provider Practice Location Address
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Address Line | 4869 PALM COAST PARKWAY NW 802
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City | PALM COAST
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State | FL
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Zip | 32145
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Country | US
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Telephone | 386-445-2003
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Fax | 386-445-7445
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Provider Business Mailing Address
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Address Line | 4869 PALM COAST PKWY NW # 802
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City | PALM COAST
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State | FL
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Zip | 32137-3661
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Country | US
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Telephone | 386-445-2003
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Fax | 386-445-7445
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARINA RABKIN
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Credential | MD
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Telephone | 386-445-2003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 92879
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License Number State | FL
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