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General NPI Number Information
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NPI Number | 1487794681
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Entity Type | Organization
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Legal Business Name | OCEANSIDE LUXURY CARE, LLC
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 01/07/2008
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Provider Practice Location Address
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Address Line | 2012 JACARANDA AVE
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City | FORT PIERCE
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State | FL
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Zip | 34949-3326
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Country | US
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Telephone | 772-216-1871
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Fax |
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Provider Business Mailing Address
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Address Line | 2012 JACARANDA AVE
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City | FORT PIERCE
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State | FL
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Zip | 34949-3326
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Country | US
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Telephone | 772-216-1871
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOHN R HAYES
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Credential | MD
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Telephone | 772-216-1871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | ME46941
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License Number State | FL
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