Jacksonville Wellness Center & Preventive Medicine Clinic

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME57227 Issued in FL

Legal business name

JACKSONVILLE WELLNESS CENTER & PREVENTIVE MEDICINE CLINIC

Practice address

3604 University Blvd S
Jacksonville, FL 32216-4241

Phone

(904) 563-5838

Fax

(904) 425-7889

NPI assigned

Mar 17, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Diana M Cordero, M.D.

Title

Medical Doctor

Phone

(904) 388-7968

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1395014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395014400000",
    "number": "1043636822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2317 BLANDING BLVD",
            "address_2": "SUITE 2",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322104194",
            "telephone_number": "904-388-7968",
            "fax_number": "904-425-7889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3604 UNIVERSITY BLVD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164241",
            "telephone_number": "904-563-5838",
            "fax_number": "904-425-7889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE WELLNESS CENTER & PREVENTIVE MEDICINE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-17",
        "last_updated": "2014-03-17",
        "status": "A",
        "authorized_official_last_name": "CORDERO",
        "authorized_official_first_name": "DIANA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "904-388-7968",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME57227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacksonville Therapy LLC
• Jacksonville University
• Jacksonville University School of Orthodontics
• Jacksonville Urgent Care LLC
• Jacksonville Wellness Center
• Jacksonville Wolfson Childrens Hospital
• Jacksonville Youth Center
• Jacksonville Youth Sanctuary
• Jacksonville Youth Sanctuary
• Jacksonville Youth Sanctuary

• Internal Medicine Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.