Andrelica Inc | |
10616 S Federal Hwy Port Saint Lucie FL 34952-6401 | |
(772) 237-4719 | |
Not Available |
Full Name | Andrelica Inc |
---|---|
Speciality | Family Medicine |
Location | 10616 S Federal Hwy, Port Saint Lucie, Florida |
Authorized Official Name and Position | Orly Pena-sanchez (OWNER) |
Authorized Official Contact | 7722374719 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Andrelica Inc 10616 S Federal Hwy Port Saint Lucie FL 34952-6401 Ph: (772) 237-4719 | Andrelica Inc 10616 S Federal Hwy Port Saint Lucie FL 34952-6401 Ph: (772) 237-4719 |
NPI Number | 1649558701 |
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Provider Enumeration Date | 07/23/2011 |
Last Update Date | 07/23/2011 |
Medicare PECOS PAC ID | 0941468326 |
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Medicare Enrollment ID | O20120215000517 |
Identifier | Type | State | Issuer |
---|---|---|---|
1649558701 | NPI | - | NPPES |
000174900 | Medicaid | FL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | ACN232 (Florida) | Primary |
Provider Name | Orly Pena Sanchez |
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Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1447212295 PECOS PAC ID: 7315962859 Enrollment ID: I20081018000123 |
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