Active NPI 1831165448 Individual Practitioner Male Practitioner

Dr. Mark W. Lastarza , MD

Internal Medicine • Ormond Beach, FL

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Mark Lastarza, MD is a certified Internal Medicine practicing in Ormond Beach, FL. With approximately 31 years of clinical experience since graduating from Washington University School Of Medicine in 1995, Dr. Lastarza delivers high-quality medical care to the local community at 335 CLYDE MORRIS BLVD.

Dr. Lastarza maintains professional affiliations with Ability Health Services And Rehabilitation Lp, Ability Health Services, Inc, Adventhealth Primary Care Network Inc and accepts Medicare assignment.

Frequently performed procedures and clinical services include established patient outpatient office visit, visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's, annual alcohol misuse screening, 5 to. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

335 Clyde Morris Blvd
Suite 290

Ormond Beach, FL 321745959

Telephone 3866723219

Fax 3866723160

Associated Practice Facility / Clinic

🏢 Florida Hospital Imaging Llc Facility NPI 1104876358

Medicare Profile & Education

Medical School

Washington University School Of Medicine

Graduation Year

1995

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Internal Medicine in Ormond Beach, FL

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

31 Yrs -4.8 yrs vs City Avg

City Avg: 35.8 Yrs

State Avg: 26.5 Yrs

Regional Practice Density

23 Specialists

Practicing in Ormond Beach, FL (10650 Statewide)

Telehealth Adoption Rate

17.4% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

67.2% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Lastarza (31 Years) 31 Yrs

Ormond Beach Specialty Average (35.8 Years) 35.8 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,626	825	$382.00	$124.95
G2211 Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's	1,166	676	$49.00	$16.10
G0442 Annual alcohol misuse screening, 5 to 15 minutes	667	667	$55.00	$18.01
G0444 Annual depression screening, 5 to 15 minutes	654	654	$55.00	$18.03
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	640	640	$385.00	$126.09
99213 Established patient office or other outpatient visit, typically 15 minutes	159	142	$270.31	$88.05
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	82	15	$42.00	$13.78
J3420 Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg	77	14	$6.16	$1.26
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	76	76	$500.00	$162.30
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	42	33	$155.00	$51.86
G0008 Administration of influenza virus vaccine	29	29	$93.00	$31.66
90653 Vaccine for influenza for injection into muscle	28	28	$178.59	$81.82
87426 Detection test by immunoassay technique for severe acute respiratory syndrome coronavirus	22	22	$136.00	$34.62
99496 Transitional care management services for problem of high complexity	21	20	$821.00	$270.29
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	21	21	$496.00	$149.11
99495 Transitional care management services for problem of at least moderate complexity	20	19	$606.00	$200.11
87804 Detection test by immunoassay with direct visual observation for influenza virus	16	16	$50.00	$16.22

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,807	806	$381.08	$127.15
G0442 Annual alcohol misuse screening, 5 to 15 minutes	631	631	$54.85	$18.10
G0444 Annual depression screening, 5 to 15 minutes	627	627	$54.85	$18.10
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	612	612	$384.35	$128.67
J3420 Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg	99	13	$6.16	$1.54
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	85	13	$41.92	$13.93
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	56	43	$154.57	$51.55
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	48	48	$499.50	$166.96
G0179 Physician re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imp	28	17	$123.00	$40.88
G0008 Administration of influenza virus vaccine	25	25	$86.55	$30.24
90662 Influenza vaccine split virus, preservative free	21	21	$209.82	$71.28
90677 Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use	20	20	$851.15	$280.71
99496 Transitional care management services for problem of high complexity	20	18	$818.00	$270.03
G0009 Administration of pneumococcal vaccine	18	18	$57.19	$30.24
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	14	14	$496.00	$151.37
G0296 Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making)	12	12	$86.00	$28.60
99406 Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes	12	12	$45.00	$14.90
99495 Transitional care management services for problem of at least moderate complexity	12	12	$602.25	$202.24

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,760	815	$383.78	$127.12
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	581	581	$391.83	$129.54
G0444 Annual depression screening, 5 to 15 minutes	580	580	$54.97	$17.98
G0442 Annual alcohol misuse screening, 5 to 15 minutes	558	558	$55.97	$18.29
85610 Blood test, clotting time	174	16	$13.00	$4.23
G0296 Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making)	134	134	$88.00	$28.93
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	106	17	$43.00	$14.14
G0008 Administration of influenza virus vaccine	102	102	$52.71	$28.68
90662 Influenza vaccine split virus, preservative free	101	101	$195.79	$68.44
J3420 Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg	92	17	$5.50	$1.71
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	51	51	$507.00	$165.80
G0179 Physician re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imp	44	20	$122.00	$40.52
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	40	35	$158.00	$52.47
G0009 Administration of pneumococcal vaccine	29	29	$52.71	$28.74
90677 Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use	25	25	$794.22	$278.05
99496 Transitional care management services for problem of high complexity	24	23	$829.00	$272.08
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	13	13	$503.00	$158.99
99213 Established patient office or other outpatient visit, typically 15 minutes	13	13	$273.00	$90.72
93000 Routine ekg using at least 12 leads including interpretation and report	13	12	$43.85	$14.16
99495 Transitional care management services for problem of at least moderate complexity	11	11	$617.00	$204.79

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,998	839	$388.67	$130.18
G0442 Annual alcohol misuse screening, 5 to 15 minutes	641	641	$54.95	$18.36
G0444 Annual depression screening, 5 to 15 minutes	624	624	$54.95	$18.36
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	623	623	$395.55	$132.69
85610 Blood test, clotting time	245	15	$13.00	$4.29
G0296 Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making)	175	175	$86.97	$29.14
J3420 Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg	112	23	$5.53	$1.98
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	112	23	$42.02	$14.08
G0008 Administration of influenza virus vaccine	105	104	$73.00	$16.43
90662 Influenza vaccine split virus, preservative free	103	102	$195.54	$64.54
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	99	17	$66.91	$22.36
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	71	71	$507.77	$168.15
G0179 Physician re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imp	59	37	$122.00	$40.99
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	41	40	$158.00	$51.58
99496 Transitional care management services for problem of high complexity	40	36	$827.55	$269.95
G0009 Administration of pneumococcal vaccine	33	33	$141.00	$16.65
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	33	33	$359.77	$125.01
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	30	29	$545.00	$177.04
99213 Established patient office or other outpatient visit, typically 15 minutes	21	21	$276.67	$84.51
99495 Transitional care management services for problem of at least moderate complexity	20	19	$610.00	$205.95
99406 Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes	18	18	$47.00	$15.77
93000 Routine ekg using at least 12 leads including interpretation and report	16	16	$45.44	$14.91
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	14	14	$503.00	$169.23

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,871	836	$327.99	$109.64
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	615	615	$346.62	$116.44
G0444 Annual depression screening, 5 to 15 minutes	458	458	$54.00	$18.08
85610 Blood test, clotting time	255	18	$13.42	$4.26
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	228	30	$69.00	$22.89
G0296 Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making)	170	169	$90.78	$30.50
J3420 Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg	135	22	$6.64	$1.99
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	133	22	$43.00	$14.26
G0442 Annual alcohol misuse screening, 5 to 15 minutes	131	131	$54.00	$18.10
G0008 Administration of influenza virus vaccine	114	113	$73.00	$16.52
90662 Influenza vaccine split virus, preservative free	111	110	$168.02	$59.99
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	92	92	$500.00	$167.47
G0009 Administration of pneumococcal vaccine	87	87	$141.00	$16.49
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	83	83	$342.64	$118.62
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	82	67	$159.61	$53.75
G0179 Physician re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imp	43	26	$122.00	$41.08
99496 Transitional care management services for problem of high complexity	31	28	$731.03	$246.17
99213 Established patient office or other outpatient visit, typically 15 minutes	28	22	$225.96	$75.80
93000 Routine ekg using at least 12 leads including interpretation and report	25	22	$52.00	$17.19
99406 Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes	20	20	$47.00	$15.61
69210 Removal of impacted ear wax	19	15	$147.68	$49.49
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	17	17	$441.00	$148.28
99495 Transitional care management services for problem of at least moderate complexity	14	14	$552.14	$185.74
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	12	12	$497.67	$166.78

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	2,152	850	$327.90	$108.28
G0442 Annual alcohol misuse screening, 5 to 15 minutes	600	600	$53.94	$17.81
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	596	596	$349.61	$115.81
G0444 Annual depression screening, 5 to 15 minutes	588	588	$53.94	$17.81
85610 Blood test, clotting time	276	22	$14.22	$4.28
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	251	37	$68.00	$22.39
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	165	28	$50.00	$16.55
J3420 Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg	165	28	$5.24	$1.80
G0296 Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making)	132	132	$88.00	$29.09
G0008 Administration of influenza virus vaccine	83	81	$73.00	$16.24
90662 Influenza vaccine split virus, preservative free	81	79	$170.08	$54.67
G0009 Administration of pneumococcal vaccine	70	70	$141.00	$16.01
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	67	67	$499.00	$165.96
99213 Established patient office or other outpatient visit, typically 15 minutes	60	43	$224.00	$74.33
93000 Routine ekg using at least 12 leads including interpretation and report	57	57	$51.40	$16.74
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	44	37	$161.00	$53.28
99496 Transitional care management services for problem of high complexity	38	35	$696.00	$225.51
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	35	35	$323.27	$105.65
90670 Pneumococcal vaccine for injection into muscle	35	35	$615.37	$208.16
99495 Transitional care management services for problem of at least moderate complexity	28	27	$493.00	$159.96
99497 Advance care planning, first 30 minutes	24	24	$260.00	$86.02
G0179 Physician re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imp	23	11	$124.00	$40.98
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	21	19	$440.00	$146.34
69210 Removal of impacted ear wax	17	16	$145.00	$47.99
99406 Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes	13	13	$46.00	$13.93

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	2,073	802	$322.00	$106.39
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	545	545	$349.00	$114.72
G0442 Annual alcohol misuse screening, 5 to 15 minutes	544	544	$54.00	$17.81
G0444 Annual depression screening, 5 to 15 minutes	512	512	$54.00	$17.48
99497 Advance care planning, first 30 minutes	470	469	$249.00	$84.04
85610 Blood test, clotting time	280	26	$17.00	$4.75
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	255	37	$110.00	$21.04
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	153	27	$76.00	$20.02
J3420 Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg	152	26	$6.28	$1.96
G0008 Administration of influenza virus vaccine	142	142	$73.00	$19.91
90662 Influenza vaccine split virus, preservative free	139	139	$147.08	$52.21
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	93	93	$498.00	$164.71
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	55	46	$162.00	$52.19
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	52	47	$435.00	$144.30
99213 Established patient office or other outpatient visit, typically 15 minutes	42	30	$219.00	$72.24
93000 Routine ekg using at least 12 leads including interpretation and report	39	39	$52.00	$16.80
99496 Transitional care management services for problem of high complexity	34	29	$694.00	$220.91
G0009 Administration of pneumococcal vaccine	27	27	$141.00	$19.91
99495 Transitional care management services for problem of at least moderate complexity	26	25	$490.00	$161.87
G0179 Physician re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imp	22	15	$124.00	$41.08
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	16	16	$296.55	$105.59
90670 Pneumococcal vaccine for injection into muscle	11	11	$577.91	$201.01

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	2,092	773	$322.11	$102.92
G0442 Annual alcohol misuse screening, 5 to 15 minutes	541	541	$54.00	$17.00
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	534	534	$349.00	$110.31
G0444 Annual depression screening, 5 to 15 minutes	522	522	$54.00	$17.00
99497 Advance care planning, first 30 minutes	335	332	$249.00	$78.55
85610 Blood test, clotting time	261	26	$17.00	$5.28
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	245	42	$110.00	$19.10
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	170	38	$76.00	$24.00
J3420 Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg	168	36	$10.47	$2.98
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	105	86	$435.00	$138.85
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	65	65	$498.00	$158.99
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	61	55	$162.00	$51.47
99496 Transitional care management services for problem of high complexity	46	41	$694.00	$217.32
99213 Established patient office or other outpatient visit, typically 15 minutes	43	35	$219.00	$68.90
93000 Routine ekg using at least 12 leads including interpretation and report	31	30	$52.00	$16.33
99495 Transitional care management services for problem of at least moderate complexity	21	21	$490.00	$155.85
69210 Removal of impacted ear wax	11	11	$149.00	$47.39

Medical Specialties & State Licenses

Internal Medicine Primary Specialty

NUCC Taxonomy Code: 207R00000X

State License FL ME0075627

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Hospital & Practice Group Affiliations

Ability Health Services And Rehabilitation Lp

1200 Lexington Green Ln, Sanford, FL 327711013

Ability Health Services, Inc

1200 Lexington Green Ln, Sanford, FL 327711013

Adventhealth Primary Care Network Inc

661 E Altamonte Dr, Altamonte Springs, FL 327015102

Phone: 4078314040

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

3 Associated Practitioners

Joanne Mora , PA-C

Physician Assistant

NPI 1154531796

Physician Assistant (Certified)

Dr. Michael Townsend , MD

Internal Medicine

NPI 1427024504

Doctor of Medicine (M.D.)

Michelle Johnston , PA

Physician Assistant

NPI 1427143809

Physician Assistant

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events

✅

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

📍

Updated Practice Location July 08, 2007

Registered at 335 CLYDE MORRIS BLVD, SUITE 290, ORMOND BEACH, FL 321745959 (Tel: 3866723219)

📍

Updated Business Mailing Address July 08, 2007

Registered at 335 CLYDE MORRIS BLVD, SUITE 290, ORMOND BEACH, FL 321745959 (Tel: 3866723219)

👤

Provider Name / Credentials Updated July 08, 2007

Recorded as MARK LASTARZA, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Internal Medicine (License #ME0075627 in FL)

🟢

Initial NPI Registration & Enumeration February 23, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1831165448

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: February 23, 2006

Last Update: July 08, 2007

Sole Proprietor: No

Update or Correct Profile

Mailing Address

335 Clyde Morris Blvd, Suite 290

Ormond Beach, FL 321745959

Phone: 3866723219

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.