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NPI Code Detail

MEDICARE: TREASURE COAST MEDICAL ASSOCIATES

MEDICARE: TREASURE COAST MEDICAL ASSOCIATES
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
1332900000XNon-Pharmacy Dispensing SiteME68270FL

General Provider Information

NPI Number : 1740689280
Entity Type Code : Organization
Provider Name (Legal Business Name) : TREASURE COAST MEDICAL ASSOCIATES
Provider Business Mailing Address
First Line : 5626 OBERLIN DR
Second Line : SUITE 110
City : SAN DIEGO
State : CA
Zip : 92121-1705
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3405 NW FEDERAL HWY
Second Line :
City : JENSEN BEACH
State : FL
Zip : 34957-4439
Country : US
Telephone Number : 772-692-8082
Fax Number :
Authorized Official
Title or Position : VP OF OPERATIONS
Name : KENNY HEINE
Credential :
Telephone Number : 858-964-1506
Provider Enumeration Date : 08/21/2014
Last Update Date : 08/21/2014

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Directions to “TREASURE COAST MEDICAL ASSOCIATES ” Practice Location

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