PRO PERFORMANCE ANTI AGING AND PHARMACEUTICAL SUPPLEMENTATION LLC NPI 1376072181

NPI Information

NPI: 1376072181
Provider Name: PRO PERFORMANCE ANTI AGING AND PHARMACEUTICAL SUPPLEMENTATION LLC
Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

Address:
4865 SW GOLFSIDE DR
PALM CITY, FL
ZIP 34990
Phone: (772) 631-1563
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PRO PERFORMANCE ANTI AGING AND PHARMACEUTICAL SUPPLEMENTATION LLC is a multi-specialty clinic center in Palm City, FL. PRO PERFORMANCE ANTI AGING AND PHARMACEUTICAL SUPPLEMENTATION LLC NPI is 1376072181. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

4865 SW GOLFSIDE DR
PALM CITY, FL
ZIP 34990-917
Phone: (772) 631-1563
Fax: (772) 463-2344

The provider's authorized official is Domenic Iacovone .
The authorized official title is President and has the following contact phone number (772) 631-1563.

The enumeration date for this NPI number is 6/6/2017 and was last updated on 6/16/2018.

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	207XX0005X	Orthopaedic Surgery	Sports Medicine	OS10791	FLORIDA	No
2	261QM1300X	Clinic/Center	Multi-Specialty	OS10791	FLORIDA	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	OS10791	OTHER	FLORIDA	GROUP PRACTICE SPECIALITY

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: 11/14/2023

NPI Synchronization or Removal

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