Provider Demographics
NPI:1124411525
Name:ARTHRITIC DISEASES CLINIC
Entity Type:Organization
Organization Name:ARTHRITIC DISEASES CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:OLAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-285-1113
Mailing Address - Street 1:130 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-1202
Mailing Address - Country:US
Mailing Address - Phone:904-285-1113
Mailing Address - Fax:904-285-3110
Practice Address - Street 1:130 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-1202
Practice Address - Country:US
Practice Address - Phone:904-285-1113
Practice Address - Fax:904-285-3110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL51858261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty