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Organization
PRODIGY MEDICAL PROFESSIONALS, LLC
Active
Organization
PRODIGY MEDICAL PROFESSIONALS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANDREA (NONE) PINE-GRIMALDI (MANAGING MEMBER (CO-OWNER))
(561) 512-6057
Entity
Organization
Contact information
Practice address
1621 RIPLEY RUN, WELLINGTON, FL 33414
(561) 512-6057
(561) 204-5093
Mailing address
1621 RIPLEY RUN, WELLINGTON, FL 33414
(561) 512-6057
(561) 204-5093
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
OT11509
FL
Other
Enumeration date
05/02/2007
Last updated
08/22/2020
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