Organization · NPI-2

Betty A Zondag, Od, PA

Clinic/Center · Port St Lucie, FL

NPI number1518264209
StatusActive
Last updated in NPPESFeb 16, 2011

Details

NPI
1518264209
Entity type
Organization (NPI-2)
Legal business name
Betty A Zondag, Od, PA
Organization subpart
No
Enumeration date
Feb 16, 2011
Last updated
Feb 16, 2011

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261Q00000X Clinic/Centeropc3413FLYes

Practice location

8960 S Federal Hwy
Port St Lucie, FL 34952-3403

Phone 772-337-6376 · Fax 772-337-3977

Mailing address

8960 S Federal Hwy
Port St Lucie, FL 34952-3403

Phone 772-337-6376 · Fax 772-337-3977

Authorized official

Betty A Zondag
President
7723376376

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