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General NPI Number Information
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NPI Number | 1952423113
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Entity Type | Organization
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Legal Business Name | PRIMA VISTA WALK-IN MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 12/03/2007
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Provider Practice Location Address
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Address Line | 784 E PRIMA VISTA BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-2271
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Country | US
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Telephone | 772-878-7311
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Fax | 772-878-7321
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Provider Business Mailing Address
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Address Line | 784 E PRIMA VISTA BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-2271
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Country | US
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Telephone | 772-878-7311
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Fax | 772-878-7321
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS SYLVIA A. MENDOZA
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Credential |
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Telephone | 772-878-7311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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