Basic Information
| Provider Information | |||||||||
| NPI: | 1548258700 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEKINE RASNER BROCK MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 17399 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322457399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042625333 | ||||||||
| FaxNumber: | 9042625337 | ||||||||
| Practice Location | |||||||||
| Address1: | 11945 SAN JOSE BLVD STE 400 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322231627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042625333 | ||||||||
| FaxNumber: | 9042625337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2005 | ||||||||
| LastUpdateDate: | 03/02/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LENTO | ||||||||
| AuthorizedOfficialFirstName: | JUDITH | ||||||||
| AuthorizedOfficialMiddleName: | HANNAH | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9042625333 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | B.S.H., C.M.P.E. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 374785900 | 05 | FL | MEDICAID |