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Organization
DIAGNOSTIC CLINIC MEDICAL GROUP, INC.
Active
Organization
DIAGNOSTIC CLINIC MEDICAL GROUP, INC.
Active
Parent organization
DIAGNOSTIC CLINIC MEDICAL GROUP, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
DIAGNOSTIC CLINIC MEDICAL GROUP, INC.
Authorized official
GINA MARIE PREBECK (VP OF OPERATIONS)
(727) 559-9461
Entity
Organization
Contact information
Practice address
1615 PASADENA AVE S STE 220, SOUTH PASADENA, FL 33707-4517
(727) 345-7100
(727) 345-7102
Mailing address
1615 PASADENA AVE S STE 220, SOUTH PASADENA, FL 33707-4517
(727) 345-7100
(727) 345-7102
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
12/04/2020
Last updated
03/16/2021
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