Healthcare Provider Details

I. General information

NPI: 1346563897
Provider Name (Legal Business Name): DCHD HEALTH CARE PROFESSIONALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NORTH ROBERT AVENUE
ARCADIA FL
34266-8712
US

IV. Provider business mailing address

900 NORTH ROBERT AVENUE
ARCADIA FL
34266-8712
US

V. Phone/Fax

Practice location:
  • Phone: 863-494-8403
  • Fax: 863-491-4328
Mailing address:
  • Phone: 863-494-8403
  • Fax: 863-491-4328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4218
License Number StateFL

VIII. Authorized Official

Name: MR. VINCENT A SICA
Title or Position: CEO
Credential:
Phone: 863-494-8403