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NPI Code Detail

MEDICARE: SANTROCK PSYCHIATRY, LLC

MEDICARE: SANTROCK PSYCHIATRY, LLC
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
12084P0800XPsychiatry PhysicianME101696FL

General Provider Information

NPI Number : 1811315104
Entity Type Code : Organization
Provider Name (Legal Business Name) : SANTROCK PSYCHIATRY, LLC
Provider Business Mailing Address
First Line : 2089 S RIDGEWOOD AVE STE B
Second Line :
City : SOUTH DAYTONA
State : FL
Zip : 32119-2240
Country : US
Telephone Number : 386-957-3905
Fax Number : 386-492-1131
Provider Business Practice Location Address
First Line : 2089 S RIDGEWOOD AVE STE B
Second Line :
City : SOUTH DAYTONA
State : FL
Zip : 32119-2240
Country : US
Telephone Number : 386-957-3905
Fax Number : 386-492-1131
Authorized Official
Title or Position : OWNER
Name : SALVADOR CEVALLOS
Credential : MD
Telephone Number : 386-957-3905
Provider Enumeration Date : 04/03/2014
Last Update Date : 11/07/2023

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Directions to “SANTROCK PSYCHIATRY, LLC ” Practice Location

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