| Stellar Performance Medical Llc | |
|
555 W Granada Blvd Ste E2 Ormond Beach FL 32174-9401 | |
| (305) 240-5901 | |
| (617) 544-0568 |
| Full Name | Stellar Performance Medical Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 555 W Granada Blvd Ste E2, Ormond Beach, Florida |
| Authorized Official Name and Position | Luis Eduardo Gomez (APRN-OWNER) |
| Authorized Official Contact | 3052405901 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stellar Performance Medical Llc Po Box 731891 Ormond Beach FL 32173-1891 Ph: () - | Stellar Performance Medical Llc 555 W Granada Blvd Ste E2 Ormond Beach FL 32174-9401 Ph: (305) 240-5901 |
| NPI Number | 1952991614 |
|---|---|
| Provider Enumeration Date | 01/26/2021 |
| Last Update Date | 01/26/2021 |
| Medicare PECOS PAC ID | 7618383589 |
|---|---|
| Medicare Enrollment ID | O20210302000773 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952991614 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Sarah J Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134220692 PECOS PAC ID: 8820193477 Enrollment ID: I20070410000631 |
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