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General NPI Number Information
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NPI Number | 1972318491
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Entity Type | Organization
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Legal Business Name | PEDIATRIC URGENT CARE GROUP OF ORMOND BEACH
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Dates
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Enumeration Date | 02/11/2025
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 1688 W GRANADA BLVD STE 1A
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City | ORMOND BEACH
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State | FL
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Zip | 32174-1818
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Country | US
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Telephone | 386-316-6276
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Fax |
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Provider Business Mailing Address
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Address Line | 1688 W GRANADA BLVD STE 1A
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City | ORMOND BEACH
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State | FL
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Zip | 32174-1818
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MD, OWNER
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Name | JAIME E QUINTEROS
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Credential |
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Telephone | 386-425-4414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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