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STELLAR PERFORMANCE MEDICAL LLC NPI 1952991614


NPI Information

NPI: 1952991614
Provider Name: STELLAR PERFORMANCE MEDICAL LLC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 10D2232502

Address:
555 W GRANADA BLVD STE E2
ORMOND BEACH, FL
ZIP 32174
Phone: (305) 240-5901
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STELLAR PERFORMANCE MEDICAL LLC is a family medicine in Ormond Beach, FL. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. STELLAR PERFORMANCE MEDICAL LLC NPI is 1952991614. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

555 W GRANADA BLVD STE E2
ORMOND BEACH, FL
ZIP 32174-401
Phone: (305) 240-5901
Fax: (617) 544-0568

The provider's authorized official is Luis Eduardo Gomez .
The authorized official title is Aprn-owner and has the following contact phone number (305) 240-5901.

The CLIA number assigned to this NPI record is 10D2232502 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/26/2021 and was last updated on 1/26/2021.


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
1207Q00000XFamily MedicineYes

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: 5/5/2024

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