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General NPI Number Information
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NPI Number | 1376661710
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Entity Type | Organization
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Legal Business Name | DELTONA MEDICAL CENTER LLC
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 02/26/2009
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Provider Practice Location Address
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Address Line | 747 FAWN RIDGE DR STE 200
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City | ORANGE CITY
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State | FL
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Zip | 32763-8268
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Country | US
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Telephone | 386-668-9800
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Fax | 386-668-9800
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Provider Business Mailing Address
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Address Line | 747 FAWN RIDGE DR STE 200
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City | ORANGE CITY
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State | FL
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Zip | 32763-8268
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Country | US
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Telephone | 386-668-9800
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Fax | 386-668-3777
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ESTHER CRISANTO
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Credential | RN
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Telephone | 386-668-9841
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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