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1301 Plantation Island Dr S Suite 402 B St Augustine FL 32080-3108 | |
| (904) 823-3777 | |
| (904) 823-3363 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 1301 Plantation Island Dr S, St Augustine, Florida |
| Authorized Official Name and Position | Rezwan Rosa Ashdji (PRESIDENT) |
| Authorized Official Contact | 9048233777 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1301 Plantation Island Dr S Suite 402 B St Augustine FL 32080-3108 Ph: (904) 823-3777 | 1301 Plantation Island Dr S Suite 402 B St Augustine FL 32080-3108 Ph: (904) 823-3777 |
| NPI Number | 1457411373 |
|---|---|
| Provider Enumeration Date | 12/11/2006 |
| Last Update Date | 04/27/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457411373 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | ME0057416 (Florida) | Primary |
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