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NPI Code Detail

MEDICARE: COAST FLORIDA P.A.

MEDICARE: COAST FLORIDA P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist

General Provider Information

NPI Number : 1558937946
Entity Type Code : Organization
Provider Name (Legal Business Name) : COAST FLORIDA P.A.
Provider Business Mailing Address
First Line : 5706 BENJAMIN CENTER DR STE 103
Second Line :
City : TAMPA
State : FL
Zip : 33634-5262
Country : US
Telephone Number : 813-288-1999
Fax Number :
Provider Business Practice Location Address
First Line : 2907 VINELAND RD
Second Line :
City : KISSIMMEE
State : FL
Zip : 34746-5505
Country : US
Telephone Number : 407-396-1288
Fax Number : 407-397-1032
Authorized Official
Title or Position : CREDENTIALING MANAGER
Name : MELODY RIVERA
Credential :
Telephone Number : 813-350-7166
Provider Enumeration Date : 05/27/2021
Last Update Date : 05/27/2021

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Directions to “COAST FLORIDA P.A. ” Practice Location

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