MEDICARE: PARETO POPULATION HEALTH MANAGEMENT PRACTICE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598396392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARETO POPULATION HEALTH MANAGEMENT PRACTICE PLLC

Provider Business Mailing Address
First Line	:	1697 KINGS RD STE 1
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-6169
Country	:	US
Telephone Number	:	904-478-5483
Fax Number	:	904-478-5577

Provider Business Practice Location Address
First Line	:	1697 KINGS RD STE 1
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-6169
Country	:	US
Telephone Number	:	904-478-5483
Fax Number	:	904-478-5577

Authorized Official
Title or Position	:	OWNER
Name	:	KENYATTA LEE
Credential	:
Telephone Number	:	904-478-5483

Provider Enumeration Date	:	01/30/2020
Last Update Date	:	08/10/2020

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