Organization
HOLISTIC FAMILY HEALTH CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH LEE DOM, AP, CHT (DIRECTOR)
(321) 385-1000
Entity
Organization
Contact information
Practice address
3620 S HOPKINS AVE, SUITE 101, TITUSVILLE, FL 32780-5707
(321) 385-1000
Mailing address
PO BOX 259, SCOTTSMOOR, FL 32775-0259
(321) 385-1000
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
AP1651
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C0840
BLUECROSS BLUESHIELD
FL
Enumeration date
12/04/2007
Last updated
12/04/2007
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