| Seacrest Medical Office Diagnostic | |
|
2848 S Seacrest Blvd Boynton Beach FL 33435-7935 | |
| (561) 738-7611 | |
| (561) 738-7622 |
| Full Name | Seacrest Medical Office Diagnostic |
|---|---|
| Speciality | Internal Medicine |
| Location | 2848 S Seacrest Blvd, Boynton Beach, Florida |
| Authorized Official Name and Position | Jean Richard Etienne (PHYSICIAN) |
| Authorized Official Contact | 5617387611 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Seacrest Medical Office Diagnostic 2848 S Seacrest Blvd Boynton Beach FL 33435-7935 Ph: (561) 738-7611 | Seacrest Medical Office Diagnostic 2848 S Seacrest Blvd Boynton Beach FL 33435-7935 Ph: (561) 738-7611 |
| NPI Number | 1700088911 |
|---|---|
| Provider Enumeration Date | 06/01/2007 |
| Last Update Date | 10/14/2020 |
| Medicare PECOS PAC ID | 5294827192 |
|---|---|
| Medicare Enrollment ID | O20070823000352 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700088911 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME94948 (Florida) | Primary |
| Provider Name | Jean Richard Etienne |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801806658 PECOS PAC ID: 5597718759 Enrollment ID: I20070312000508 |
| Provider Name | Sophia Delva |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598351231 PECOS PAC ID: 6406252899 Enrollment ID: I20210910000011 |
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