Organization
SPACE COAST ENDOCRINOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDI LAROCHE (MSO CREDENTIALING COORDINATOR)
(321) 449-4168
Entity
Organization
Contact information
Practice address
835 EXECUTIVE LN, SUITE 110, ROCKLEDGE, FL 32955-8068
(321) 638-2075
(321) 638-2234
Mailing address
150 N SYKES CREEK PKWY, SUITE 300, MERRITT ISLAND, FL 32953-3488
(321) 449-4168
(321) 449-4164
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
—
Other
Enumeration date
02/05/2007
Last updated
04/28/2010
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