Healthcare Provider Details

I. General information

NPI: 1538659305
Provider Name (Legal Business Name): BRADENTON WOMENS CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 59TH ST W
BRADENTON FL
34209-4630
US

IV. Provider business mailing address

1814 59TH ST W
BRADENTON FL
34209-4630
US

V. Phone/Fax

Practice location:
  • Phone: 941-761-1111
  • Fax: 941-761-1120
Mailing address:
  • Phone: 941-761-1111
  • Fax: 941-761-1120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: VERONICA SOCAS
Title or Position: MEMBER
Credential: MD
Phone: 941-761-1111