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Organization
PRESTIGE OUTPATIENT PROVIDERS, LLC
Active
Organization
PRESTIGE OUTPATIENT PROVIDERS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OKSANA RUSTAMOVA (CREDENTIALING SPECIALIST)
(646) 517-1257
Entity
Organization
Contact information
Practice address
2338 IMMOKALEE RD # 186, NAPLES, FL 34110-1445
(239) 330-2933
Mailing address
2338 IMMOKALEE RD # 141, NAPLES, FL 34110-1445
(239) 330-2933
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
12/07/2018
Last updated
12/21/2018
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