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General NPI Number Information
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NPI Number | 1730415258
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Entity Type | Organization
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Legal Business Name | OCEANVIBES, INC.
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Dates
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Enumeration Date | 10/19/2009
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Last Update Date | 10/19/2009
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Provider Practice Location Address
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Address Line | 21 GRANT ST
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32084-2739
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Country | US
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Telephone | 904-823-8633
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Fax |
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Provider Business Mailing Address
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Address Line | 305 4TH ST
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32084-1437
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Country | US
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Telephone | 904-823-8633
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS ELIZABETH A ZYLKOWSKI
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Credential | LMT
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Telephone | 904-318-0328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA 43881
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA 53341
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MM 16528
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License Number State | FL
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