Provider Demographics
NPI:1245877547
Name:VIJAPURA SPINE & SPORTS MEDICINE, PA
Entity type:Organization
Organization Name:VIJAPURA SPINE & SPORTS MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPORTS MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:VIJAPURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-400-3987
Mailing Address - Street 1:8236 CHESTER LAKE RD N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-3402
Mailing Address - Country:US
Mailing Address - Phone:904-400-3987
Mailing Address - Fax:
Practice Address - Street 1:9141 CYPRESS GREEN DR STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-2006
Practice Address - Country:US
Practice Address - Phone:904-400-3987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty