Organization
ADV AN CED FLORIDA MEDICAL GROUP, CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ODALIS MAZA MOREJON (PRESIDENT)
(239) 590-8570
Entity
Organization
Contact information
Practice address
3900 BROADWAY STE D-9, FORT MYERS, FL 33901-8193
(239) 590-8570
Mailing address
3900 BROADWAY, SUITE D-9, FORT MYERS, FL 33901
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
HCC10633
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1649626409
ARNP
FL
Enumeration date
06/14/2016
Last updated
09/22/2016
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