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Organization

JULINGTON CREEK PEDIATRICS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. VICTORIA MOSTELLER MD (PEDIATRIC PHYSICIAN)
(904) 230-5437
Entity
Organization

Contact information

Practice address
774 STATE ROAD 13, SUITE 6, SAINT JOHNS, FL 32259-3857
(904) 230-5437
(904) 230-7337
Mailing address
774 STATE ROAD 13, SUITE 6, SAINT JOHNS, FL 32259-3857
(904) 230-5437
(904) 230-7337

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME74170
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1679682264
TRICARE
FL
Enumeration date
05/06/2010
Last updated
05/06/2010
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