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General NPI Number Information
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NPI Number | 1851856652
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Entity Type | Organization
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Legal Business Name | JC PHYSICIAN ASSOCIATES PLLC
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Dates
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Enumeration Date | 02/05/2019
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Last Update Date | 10/09/2019
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Provider Practice Location Address
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Address Line | 3319 S STATE ROAD 7 STE 105
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City | WELLINGTON
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State | FL
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Zip | 33449-8099
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Country | US
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Telephone | 561-557-3115
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Fax | 561-425-5147
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Provider Business Mailing Address
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Address Line | 3319 S STATE ROAD 7 STE 105
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City | WELLINGTON
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State | FL
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Zip | 33449-8099
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Country | US
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Telephone | 561-557-3115
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Fax | 561-425-5147
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Authorized Official
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Title or Position | MANAGER
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Name | STEVEN RUEDA
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Credential | MD
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Telephone | 305-972-5299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2086S0105X
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Taxonomy Name | Surgery of the Hand (Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2082S0105X
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Taxonomy Name | Surgery of the Hand (Plastic Surgery) Physician
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License Number |
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License Number State |
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