| Living The Dream 63 Llc | |
|
3182 Dunbar Ln Tallahassee FL 32311-3362 | |
| (850) 264-5998 | |
| (850) 329-2195 |
| Full Name | Living The Dream 63 Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 3182 Dunbar Ln, Tallahassee, Florida |
| Authorized Official Name and Position | David Castillo (OWNER/MANAGER) |
| Authorized Official Contact | 8502645998 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Living The Dream 63 Llc 3182 Dunbar Ln Tallahassee FL 32311-3362 Ph: (850) 264-5998 | Living The Dream 63 Llc 3182 Dunbar Ln Tallahassee FL 32311-3362 Ph: (850) 264-5998 |
| NPI Number | 1174104277 |
|---|---|
| Provider Enumeration Date | 04/20/2021 |
| Last Update Date | 04/20/2021 |
| Medicare PECOS PAC ID | 1759799042 |
|---|---|
| Medicare Enrollment ID | O20210819003670 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174104277 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Primary |
| Provider Name | David Castillo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114286267 PECOS PAC ID: 7012132129 Enrollment ID: I20150730011446 |
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