Individual
JON JORGE RISOVAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1530 CORNERSTONE BLVD STE 120, DAYTONA BEACH, FL 32117-7129
(386) 310-3529
(386) 310-2106
Mailing address
222 S PENINSULA DR, DAYTONA BEACH, FL 32118-4422
(386) 310-3529
(386) 310-2106
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME146328
FL
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/28/2018
Last updated
01/22/2025
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