NPI 1063671683

Medical Pavilion Clinc

Organisation Preferred Provider Organization Port Charlotte, FL

Practice location

Address: 2525 Harbor Blvd Suite 102, Port Charlotte, FL 33952-5317
Phone: (941) 629-9190
Fax: (941) 625-2751

Authorised official

Name: David S Ballestas
Title: Doctor - Owner
Phone: (941) 629-9190

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence ME0044391 (FL)

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Registry record

NPI: 1063671683
Entity type: Organization
NPI issued: 9 Jun 2008
Record last updated: 9 Jun 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.