Organization
ABA FAMILY MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIEGO T TORRES II M.D. (MANAGING MEMBER)
(386) 676-2367
Entity
Organization
Contact information
Practice address
325 CLYDE MORRIS BLVD, SUITE 320, ORMOND BEACH, FL 32174-8178
(386) 676-2367
(386) 615-6402
Mailing address
325 CLYDE MORRIS BLVD, SUITE 320, ORMOND BEACH, FL 32174-8178
(386) 676-2367
(386) 615-6402
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME79483
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DA2451
MEDICARE RAILROAD
FL
01
—
K4519
MEDICARE GROUP NUMBER
FL
01
—
P00039042
MEDICARE RAILROAD INDIVID
FL
Enumeration date
10/01/2007
Last updated
10/01/2007
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