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General NPI Number Information
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NPI Number | 1699216515
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Entity Type | Organization
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Legal Business Name | FLORIDA SLEEP SOLUTIONS INC
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Dates
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Enumeration Date | 03/10/2017
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Last Update Date | 03/10/2017
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Provider Practice Location Address
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Address Line | 13453 N MAIN ST STE 202
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City | JACKSONVILLE
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State | FL
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Zip | 32218-2773
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Country | US
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Telephone | 904-683-0687
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Fax | 904-575-4131
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Provider Business Mailing Address
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Address Line | 13453 N MAIN ST STE 202
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City | JACKSONVILLE
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State | FL
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Zip | 32218-2773
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Country | US
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Telephone | 904-683-0687
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Fax | 904-575-4131
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Authorized Official
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Title or Position | VICEPRESIDENT
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Name | DR. JUAN CARLOS IZURIETA
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Credential | MD, RPSGT
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Telephone | 904-718-8018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number | HCC10359
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License Number State | FL
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