Organization
DIETITIANS OF PALM VALLEY
Active
Organization
DIETITIANS OF PALM VALLEY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMANTHA ELISE PREVITE RD (CO-OWNER)
(724) 816-5561
Entity
Organization
Contact information
Practice address
230 CANAL BLVD STE 2, PONTE VEDRA, FL 32082-3745
(904) 250-0075
Mailing address
230 CANAL BLVD STE 2, PONTE VEDRA, FL 32082-3745
(904) 250-0075
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
11/07/2019
Last updated
11/07/2019
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