Organization
OP MEDICAL LLC
Active
Organization
OP MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREW JOSEPH OTTAVIANI (CLINIC DIRECTOR)
(386) 366-9119
Entity
Organization
Contact information
Practice address
1515 HERBERT ST, STE 209, PORT ORANGE, FL 32129-6104
(386) 366-9119
Mailing address
1515 HERBERT ST, STE 209, PORT ORANGE, FL 32129-6104
(386) 366-9119
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
ME0067232
FL
Other
Enumeration date
08/19/2009
Last updated
08/19/2009
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