Provider Demographics
NPI:1679931372
Name:JAX VISITING MEDICAL PROVIDERS LLC
Entity type:Organization
Organization Name:JAX VISITING MEDICAL PROVIDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LILIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:OBRERO-GINES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-513-4947
Mailing Address - Street 1:1600 SHEFFIELD PARK CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-2667
Mailing Address - Country:US
Mailing Address - Phone:904-382-2608
Mailing Address - Fax:904-221-9408
Practice Address - Street 1:9957 MOORINGS DR
Practice Address - Street 2:204
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-2412
Practice Address - Country:US
Practice Address - Phone:904-513-4947
Practice Address - Fax:904-513-4948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty