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General NPI Number Information
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NPI Number | 1720125479
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Entity Type | Organization
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Legal Business Name | BEACH MEDICAL SPECIALIST PA
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 03/06/2024
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Provider Practice Location Address
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Address Line | 9860 BEACH BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32246-4704
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Country | US
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Telephone | 904-200-2978
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Fax | 904-807-9114
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Provider Business Mailing Address
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Address Line | 9860 BEACH BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32246-4704
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Country | US
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Telephone | 904-200-2978
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Fax | 904-807-9114
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALEJANDRO CABIGTING DIZON
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Credential | MD
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Telephone | 904-200-2978
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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 | ME88405
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License Number State | FL
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