Provider Demographics
NPI:1700275310
Name:AVECINA MEDICAL, PA
Entity Type:Organization
Organization Name:AVECINA MEDICAL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLEYMANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-962-7396
Mailing Address - Street 1:9580 APPLECROSS RD
Mailing Address - Street 2:106
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-5845
Mailing Address - Country:US
Mailing Address - Phone:904-778-9180
Mailing Address - Fax:904-778-9740
Practice Address - Street 1:1633 RACE TRACK RD
Practice Address - Street 2:101
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-3234
Practice Address - Country:US
Practice Address - Phone:904-230-6988
Practice Address - Fax:904-342-4028
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AVECINA MEDICAL, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-20
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site