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General NPI Number Information
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NPI Number | 1437637402
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Entity Type | Organization
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Legal Business Name | PHYSIATRY CONSULTS OF JACKSONVILLE. LLC
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Dates
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Enumeration Date | 08/01/2018
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Last Update Date | 08/01/2018
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Provider Practice Location Address
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Address Line | 1750 STOCKTON ST
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4664
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Country | US
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Telephone | 190-486-0112
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Fax |
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Provider Business Mailing Address
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Address Line | 836 BAYTREE LN
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32082-4162
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Country | US
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Telephone | 904-860-1123
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | DR. NATALYA BULAEVA BULAEVA
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Credential | MD
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Telephone | 904-860-1123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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