Healthcare Provider Details

I. General information

NPI: 1740042936
Provider Name (Legal Business Name): PICARE CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 NE 5TH ST
BOCA RATON FL
33432-4048
US

IV. Provider business mailing address

382 NE 191ST ST PMB 14773
MIAMI FL
33179-3899
US

V. Phone/Fax

Practice location:
  • Phone: 415-903-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. AVERY J KNAPP JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 415-903-2000