Organization
PATH MEDICAL, LLC
Active
Organization
PATH MEDICAL, LLC
Active
Other names
Path Medical- Port St. Lucie
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NEIL BONNARDEL MD (DIRECTOR OF MEDICAL SERVICES)
(754) 218-2164
Entity
Organization
Contact information
Practice address
549 NW LAKE WHITNEY PL STE 101, PORT ST LUCIE, FL 34986-1606
(772) 732-7874
(772) 300-9093
Mailing address
2304 W OAKLAND PARK BLVD, OAKLAND PARK, FL 33311-1422
(754) 218-2164
(954) 473-0029
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HCC10776
STATE LICENSE
FL
Enumeration date
02/24/2016
Last updated
02/05/2021
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