Organization
WATERS MEDICAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THANHMY T NGUYEN M.D. (OPERATING MANAGER)
(813) 885-9091
Entity
Organization
Contact information
Practice address
4040 W WATERS AVE, SUITE 103, TAMPA, FL 33614-1958
(813) 885-9091
(813) 885-3527
Mailing address
PO BOX 261825, TAMPA, FL 33685-1825
(813) 885-9091
(813) 885-3527
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
05/17/2010
Last updated
11/23/2012
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