Healthcare Provider Details

I. General information

NPI: 1548864192
Provider Name (Legal Business Name): DR. MATTEO VACCARELLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9846 GLADES RD
BOCA RATON FL
33434-3917
US

IV. Provider business mailing address

9846 GLADES RD
BOCA RATON FL
33434-3917
US

V. Phone/Fax

Practice location:
  • Phone: 561-852-5603
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS61908
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: