| Organization Name: | PEDIATRIC URGENT CARE GROUP OF ORMOND BEACH |
| NPI Number: | 1083831192 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAIME E QUINTEROS (PRESIDENT) |
| Mailing Address: | 1688 W Granada Blvd Suite 1a Ormond Beach |
| State: | FL US |
| Postal Code: | 321741851 |
| Phone Number: | 3866154414 |
| Fax Number: | 3866158466 |
| NPI Enumeration Date: | 04/19/2007 |
| NPI Last Update Date: | 11/17/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |