BEACHES PEDIATRICS PA NPI 1295989606

NPI Information

NPI: 1295989606
Provider Name: BEACHES PEDIATRICS, PA
Classification: Pediatrics - 2080A0000X
Entity Type: Organization

Specialization: Adolescent Medicine

CLIA Number: 10D1075329

Address:
13820 OLD SAINT AUGUSTINE RD STE 101
JACKSONVILLE, FL
ZIP 32258
Phone: (904) 260-2565
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BEACHES PEDIATRICS, PA is an adolescent medicine pediatrics in Jacksonville, FL. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. BEACHES PEDIATRICS, PA NPI is 1295989606. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

13820 OLD SAINT AUGUSTINE RD STE 101
JACKSONVILLE, FL
ZIP 32258-424
Phone: (904) 260-2565

The provider's authorized official is Jorge Rivera-jimenez .
The authorized official title is President and has the following contact phone number (904) 246-8684.

The CLIA number assigned to this NPI record is 10D1075329 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/12/2008 and was last updated on 8/9/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207V00000X	Obstetrics & Gynecology				No
2	2080A0000X	Pediatrics	Adolescent Medicine			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	018225000	MEDICAID	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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