| Afermin Primary Care Pa | |
|
2089 S Ridgewood Ave South Daytona FL 32119-2240 | |
| (386) 767-7533 | |
| Not Available |
| Full Name | Afermin Primary Care Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 2089 S Ridgewood Ave, South Daytona, Florida |
| Authorized Official Name and Position | Patrick John Larrazabal (OWNER/PROVIDER) |
| Authorized Official Contact | 3863341295 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Afermin Primary Care Pa 500 Memorial Cir Ste A Ormond Beach FL 32174-5054 Ph: (386) 334-1295 | Afermin Primary Care Pa 2089 S Ridgewood Ave South Daytona FL 32119-2240 Ph: (386) 767-7533 |
| NPI Number | 1740673300 |
|---|---|
| Provider Enumeration Date | 03/06/2015 |
| Last Update Date | 03/28/2018 |
| Medicare PECOS PAC ID | 2961792494 |
|---|---|
| Medicare Enrollment ID | O20160613000082 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740673300 | NPI | - | NPPES |
| 069436300 | Medicaid | FL | |
| 266766500 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME0020477 (Florida) | Primary |
| 207R00000X | Internal Medicine | ME0086562 (Florida) | Secondary |
| Provider Name | Patrick N Larrazabal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518923275 PECOS PAC ID: 5597731497 Enrollment ID: I20040902000423 |
| Provider Name | Fermin A Ano |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326131400 PECOS PAC ID: 9234143132 Enrollment ID: I20060131000233 |
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