Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Medical Pavilion Clinc

Organization Preferred Provider Organization · NPI 1063671683

Medical Pavilion Clinc is a Preferred Provider Organization in Port Charlotte, Florida. Licensed in Florida. Registered with an NPI since 2008.

Licensed in
FL
In the registry since
2008
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Practice location Address checks out

2525 Harbor Blvd Ste 102
Port Charlotte, FL 33952-5317
Phone: (941) 629-9190
Fax: (941) 625-2751
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Preferred Provider Organization (primary) Taxonomy 305R00000X · Licence ME0044391 (FL)

Record details

NPI number1063671683
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official David Ballestas — Doctor - Owner · (941) 629-9190
NPI enumeratedJune 9, 2008
Last updated in NPPESJune 9, 2008
Mailing address2525 Harbor Blvd, Suite 102, Port Charlotte, FL 33952-5317

Other providers in Port Charlotte