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General NPI Number Information
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NPI Number | 1891036372
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Entity Type | Organization
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Legal Business Name | COLLIER MEDICAL, LLC
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Dates
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Enumeration Date | 03/08/2013
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Last Update Date | 03/08/2013
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Provider Practice Location Address
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Address Line | 12565 COLLIER BLVD
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City | NAPLES
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State | FL
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Zip | 34116-5243
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Country | US
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Telephone | 239-455-9919
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Fax | 239-455-9906
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Provider Business Mailing Address
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Address Line | 15725 WILLO PINES LN
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City | MONTVERDE
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State | FL
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Zip | 34756-3500
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Country | US
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Telephone | 862-377-4088
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELVIRA TOLENTINO
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Credential | M.D.
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Telephone | 862-377-4088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME113936
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License Number State | FL
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