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General NPI Number Information
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NPI Number | 1891418141
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Entity Type | Organization
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Legal Business Name | AVS MEDICAL LLC
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Dates
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Enumeration Date | 09/21/2022
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Last Update Date | 09/21/2022
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Provider Practice Location Address
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Address Line | 4691 OLD CANOE CREEK RD
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City | SAINT CLOUD
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State | FL
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Zip | 34769-1550
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Country | US
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Telephone | 407-498-4015
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Fax |
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Provider Business Mailing Address
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Address Line | 8149 GAMEMASTER AVE
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City | ORLANDO
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State | FL
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Zip | 32832-5074
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Country | US
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Telephone | 787-969-0534
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/ OWNER
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Name | DR. AGUSTIN VEGA SANTIAGO
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Credential | MD
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Telephone | 787-969-0534
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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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