| Beach Medical Specialist Pa | |
|
9860 Beach Blvd Jacksonville FL 32246-4704 | |
| (904) 200-2978 | |
| (904) 807-9114 |
| Full Name | Beach Medical Specialist Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 9860 Beach Blvd, Jacksonville, Florida |
| Authorized Official Name and Position | Alejandro Cabigting Dizon (PRESIDENT) |
| Authorized Official Contact | 9042002978 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beach Medical Specialist Pa 9860 Beach Blvd Jacksonville FL 32246-4704 Ph: (904) 200-2978 | Beach Medical Specialist Pa 9860 Beach Blvd Jacksonville FL 32246-4704 Ph: (904) 200-2978 |
| NPI Number | 1720125479 |
|---|---|
| Provider Enumeration Date | 01/31/2007 |
| Last Update Date | 03/06/2024 |
| Medicare PECOS PAC ID | 5193897296 |
|---|---|
| Medicare Enrollment ID | O20080707000588 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720125479 | NPI | - | NPPES |
| 272420100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME88405 (Florida) | Primary |
| Provider Name | Alejandro C Dizon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225057193 PECOS PAC ID: 8628031424 Enrollment ID: I20041116000347 |
| Provider Name | Chinenye Ezedike |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437319159 PECOS PAC ID: 1658533476 Enrollment ID: I20120424000221 |
| Provider Name | Naji Nouneh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699708222 PECOS PAC ID: 1052395787 Enrollment ID: I20130501000353 |
| Provider Name | Tatiana Vasylievna Barsukova |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1093974057 PECOS PAC ID: 5496935710 Enrollment ID: I20140826002723 |
| Provider Name | Jeffrey L Vongjesda |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003286824 PECOS PAC ID: 6901199645 Enrollment ID: I20170223001539 |
| Provider Name | Analyn Tesoro-ofiara |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225529761 PECOS PAC ID: 9032450069 Enrollment ID: I20190401001296 |
| Provider Name | Antonette Francisco Arevalo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285242743 PECOS PAC ID: 9436552692 Enrollment ID: I20211019003294 |
| Provider Name | Meinrado Pontejos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184209249 PECOS PAC ID: 7911394028 Enrollment ID: I20220420000040 |
| Provider Name | Jean Serna |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831876697 PECOS PAC ID: 0446605331 Enrollment ID: I20231012002282 |
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