OP MEDICAL LLC
Psychiatric at Herbert St, Daytona Beach, FL

License number
Florida ME0067232
Category
Psychiatric
Type
Interventional Pain Medicine
Owner
Name: DR. ANDREW JOSEPH OTTAVIANI
Title: CLINIC DIRECTOR
Phone: (386) 366-9119
Address
Address
1515 Herbert St STE 209, Daytona Beach, FL 32129
National Provider ID: 1144452582
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

See more information about OP MEDICAL LLC at bizstanding.com

OP MEDICAL LLC

1515 Herbert St SUITE 209, Port Orange, FL 32129

Status:
Inactive
Inactive reason:
LC AMENDMENT
Registration:
Jul 16, 2009
Inactive since:
Jun 20, 2012
State ID:
L09000068624
Business type:
Florida Limited Liability Company
Managing Members:
Picchillo, Anthony Cdr, 1515 Herbert St SUITE 209, Port Orange, FL 32129 (Physical),Anthony C. Picchillo (Managing Member),Andrew J. Ottaviani Managing Member, inactive
Agent:
Anthony Picchiello,1515 Herbert St SUITE 209, Port Orange, FL 32129 (Physical)
EIN:
270563223

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