Provider Demographics
NPI:1598396392
Name:PARETO POPULATION HEALTH MANAGEMENT PRACTICE PLLC
Entity Type:Organization
Organization Name:PARETO POPULATION HEALTH MANAGEMENT PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENYATTA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-478-5483
Mailing Address - Street 1:1697 KINGS RD STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-6169
Mailing Address - Country:US
Mailing Address - Phone:904-478-5483
Mailing Address - Fax:904-478-5577
Practice Address - Street 1:1697 KINGS RD STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6169
Practice Address - Country:US
Practice Address - Phone:904-478-5483
Practice Address - Fax:904-478-5577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty