Amron Vitality and Wellness Center, LLC

Primary specialty

Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X

Legal business name

AMRON VITALITY AND WELLNESS CENTER, LLC

Practice address

6339 Argyle Forest Blvd Ste 3
Jacksonville, FL 32244-6601

Phone

(904) 802-7048

Fax

(904) 802-7068

NPI assigned

Sep 17, 2019

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, MD

Title

Owner

Phone

(904) 802-7048

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1568678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568678400000",
    "number": "1619527157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6339 ARGYLE FOREST BLVD STE 3",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322446601",
            "telephone_number": "904-802-7048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6339 ARGYLE FOREST BLVD STE 3",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322446601",
            "telephone_number": "904-802-7048",
            "fax_number": "904-802-7068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMRON VITALITY AND WELLNESS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-17",
        "last_updated": "2019-09-17",
        "status": "A",
        "authorized_official_last_name": "CORDERO",
        "authorized_official_first_name": "DIANA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-802-7048",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RA0401X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER",
            "identifier": "10185B",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2019; 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.