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General NPI Number Information
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NPI Number | 1578111936
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Entity Type | Organization
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Legal Business Name | OASIS MEDICAL GROUP CLINIC, LLC
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Dates
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Enumeration Date | 08/29/2019
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Last Update Date | 08/29/2019
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Provider Practice Location Address
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Address Line | 7385 RADIO RD STE 104-D
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City | NAPLES
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State | FL
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Zip | 34104-6704
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Country | US
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Telephone | 239-434-6000
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Fax | 239-434-6018
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Provider Business Mailing Address
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Address Line | 7385 RADIO RD STE 104-D
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City | NAPLES
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State | FL
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Zip | 34104-6704
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Country | US
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Telephone | 239-434-6000
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Fax | 239-434-6018
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Authorized Official
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Title or Position | PHYSICIAN ASSITANT/CEO
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Name | JOSE MANUEL ALMANZAR
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Credential | PHYSICIAN ASSISTANT
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Telephone | 239-285-6649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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