| Myrtle Ridge Primary Care, P.a | |
|
1539 Dale Mabry Hwy Ste 102 Lutz FL 33548-3008 | |
| (813) 909-7102 | |
| (813) 909-0199 |
| Full Name | Myrtle Ridge Primary Care, P.a |
|---|---|
| Speciality | General Practice |
| Location | 1539 Dale Mabry Hwy Ste 102, Lutz, Florida |
| Authorized Official Name and Position | Yudaisy Mogena Padron (OWNER) |
| Authorized Official Contact | 8139097102 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Myrtle Ridge Primary Care, P.a 1539 Dale Mabry Hwy Ste 102 Lutz FL 33548-3008 Ph: () - | Myrtle Ridge Primary Care, P.a 1539 Dale Mabry Hwy Ste 102 Lutz FL 33548-3008 Ph: (813) 909-7102 |
| NPI Number | 1619504354 |
|---|---|
| Provider Enumeration Date | 03/24/2020 |
| Last Update Date | 01/08/2026 |
| Certification Date | 01/08/2026 |
| Medicare PECOS PAC ID | 7618396144 |
|---|---|
| Medicare Enrollment ID | O20201001001641 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619504354 | NPI | - | NPPES |
| 10D1050075 | Other | FL | CLIA |
| 129484600 | Medicaid | FL | |
| 129485400 | Medicaid | FL |
| Provider Name | William E Torres |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1144460684 PECOS PAC ID: 2062685779 Enrollment ID: I20210324001460 |
| Provider Name | Aylin Echazabal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770214645 PECOS PAC ID: 6608245147 Enrollment ID: I20221206001145 |
| Provider Name | Denisleydis Denis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821597014 PECOS PAC ID: 6103238597 Enrollment ID: I20221206003478 |
| Provider Name | Priscilla Molina |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1982071056 PECOS PAC ID: 0143665091 Enrollment ID: I20240229004585 |
| Provider Name | Raul Medina Rojo |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1548986987 PECOS PAC ID: 2860833118 Enrollment ID: I20240517000063 |
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