Healthcare Provider Details

I. General information

NPI: 1194976126
Provider Name (Legal Business Name): ENVITA FAMILY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 09/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8759 E BELL RD BLDG G
SCOTTSDALE AZ
85260-1322
US

IV. Provider business mailing address

PO BOX 2065
HOUSTON TX
77252-2065
US

V. Phone/Fax

Practice location:
  • Phone: 602-569-4144
  • Fax: 602-569-4244
Mailing address:
  • Phone: 800-785-8765
  • Fax: 281-453-1945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SANTO DINO PRATO
Title or Position: PRESIDENT
Credential:
Phone: 480-694-8852