1336238484 NPI number — ADULT MEDICINE SPECIALISTS, PLLC

Table of content: (NPI 1336238484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336238484 NPI number — ADULT MEDICINE SPECIALISTS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADULT MEDICINE SPECIALISTS, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336238484
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18 CAMBRIA RD E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM BEACH GARDENS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33418-7027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-627-7766
Provider Business Mailing Address Fax Number:
561-745-7876

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
207
Provider Business Practice Location Address City Name:
JUPITER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-627-7766
Provider Business Practice Location Address Fax Number:
561-745-7876
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ULLOA
Authorized Official First Name:
LUIS
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-627-7766

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME38283 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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