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General NPI Number Information
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NPI Number | 1699574327
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Entity Type | Organization
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Legal Business Name | GLADES MEDICAL OFFICES LLC
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Dates
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Enumeration Date | 03/13/2025
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 1880 SE PORT ST LUCIE BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-5545
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Country | US
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Telephone | 772-288-4911
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Fax |
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Provider Business Mailing Address
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Address Line | 1732 S CONGRESS AVE STE 346
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City | PALM SPRINGS
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State | FL
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Zip | 33461-2140
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Country | US
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Telephone | 561-353-1225
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Fax | 561-353-1226
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | TONI TERESI
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Credential |
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Telephone | 613-531-2255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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