Provider Demographics
NPI:1396201752
Name:BLUEBERRY MEDICAL PA
Entity Type:Organization
Organization Name:BLUEBERRY MEDICAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-497-9207
Mailing Address - Street 1:2672 BAYSHORE PKWY STE 608
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-1017
Mailing Address - Country:US
Mailing Address - Phone:407-497-9203
Mailing Address - Fax:
Practice Address - Street 1:246 OAKHURST CIR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4752
Practice Address - Country:US
Practice Address - Phone:407-497-9207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty