Organization
BERNARD A. PRUDENCIO M.D.PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA PRUDENCIO (OFFICE MANAGER)
(386) 467-9047
Entity
Organization
Contact information
Practice address
673 THIRD AVE, WELAKA, FL 32193-0619
(386) 467-9047
(386) 467-8512
Mailing address
673 THIRD AVE, PO BOX 619, WELAKA, FL 32193-0619
(386) 467-9047
(386) 467-8512
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
10/15/2010
Last updated
10/15/2010
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