MYRTLE RIDGE PRIMARY CARE P.A NPI 1619504354

NPI Information

MYRTLE RIDGE PRIMARY CARE, P.A is an adult medicine family medicine in Lutz, FL. The provider is the National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code. MYRTLE RIDGE PRIMARY CARE, P.A NPI is 1619504354. The provider is registered as an organization entity type.
The provider Is Doing Business As Myrtle Ridge Primary Care, P.a.

The provider's business location address is:

1539 DALE MABRY HWY STE 102
LUTZ, FL
ZIP 33548-008
Phone: (813) 909-7102
Fax: (813) 909-0199

The provider's authorized official is Yudaisy Mogena Padron .
The authorized official title is Office Manager and has the following contact phone number (813) 909-7102.

The enumeration date for this NPI number is 3/24/2020 and was last updated on 12/19/2022.

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:

Other Identifiers

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