Ketamine Wellness Institute Of Jacksonville Beach, LLC
Pain Medicine, Interventional Pain Medicine in Jacksonville Beach, FL. Organization (NPI-2).
NPI number1487471918
StatusActive
Last updated in NPPESSep 25, 2024
Details
- NPI
- 1487471918
- Entity type
- Organization (NPI-2)
- Legal business name
- Ketamine Wellness Institute Of Jacksonville Beach, LLC
- Organization subpart
- No
- Enumeration date
- Sep 25, 2024
- Certification date
- Sep 25, 2024
- Last updated
- Sep 25, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208VP0014X | Pain Medicine, Interventional Pain Medicine | – | – | Yes |
Practice location
1361 13th Ave S Ste 140Jacksonville Beach, FL 32250-3263
Phone 904-373-8153
Mailing address
1361 13th Ave S Ste 140Jacksonville Beach, FL 32250-3263
Phone 904-373-8153
Authorized official
Sathavaram Reddy
Owner
9043738153
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