Organization
AFERMIN PRIMARY CARE PA
Active
Parent organization
FLETA MEDICAL CARE CENTER LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
FLETA MEDICAL CARE CENTER LLC
Authorized official
DR. PATRICK JOHN LARRAZABAL M.D. (OWNER/PROVIDER)
(386) 334-1295
Entity
Organization
Contact information
Practice address
2089 S RIDGEWOOD AVE, SOUTH DAYTONA, FL 32119-2240
(386) 767-7533
Mailing address
500 MEMORIAL CIR STE A, ORMOND BEACH, FL 32174-5054
(386) 334-1295
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME0020477
FL
207R00000X
Internal Medicine Physician
ME0086562
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
069436300
—
FL
05
—
266766500
—
FL
Enumeration date
03/06/2015
Last updated
03/28/2018
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