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General NPI Number Information
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NPI Number | 1487194981
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Entity Type | Organization
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Legal Business Name | TRAVEL MEDICINE & INFECTIOUS DISEASES OF THE PALM BEACHES LLC
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Dates
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Enumeration Date | 03/02/2017
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Last Update Date | 02/18/2022
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Provider Practice Location Address
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Address Line | 5401 S CONGRESS AVE STE 201
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City | ATLANTIS
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State | FL
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Zip | 33462-6637
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Country | US
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Telephone | 561-967-0101
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Fax | 561-967-6260
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Provider Business Mailing Address
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Address Line | 10115 FOREST HILL BLVD SUITE 102
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City | WELLINGTON
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State | FL
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Zip | 33414-3105
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Country | US
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Telephone | 561-967-0101
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Fax | 561-967-6260
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DIANE ESCOBEDO
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Credential |
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Telephone | 561-967-0101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | ME0094948
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License Number State | FL
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