Provider Demographics
NPI:1245554799
Name:DIABETICO INTERNACIONAL, INC.
Entity type:Organization
Organization Name:DIABETICO INTERNACIONAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAVERN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBSTER-DOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:BSN,RN,CDE
Authorized Official - Phone:904-253-7967
Mailing Address - Street 1:2520 UNIVERSITY BLVD W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2004
Mailing Address - Country:US
Mailing Address - Phone:904-914-8947
Mailing Address - Fax:904-895-4729
Practice Address - Street 1:2520 UNIVERSITY BLVD W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2004
Practice Address - Country:US
Practice Address - Phone:904-914-8947
Practice Address - Fax:904-895-4729
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIABETICO INTERNATIONAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-25
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X
FL3300612163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty