Healthcare Provider Details

I. General information

NPI: 1992622047
Provider Name (Legal Business Name): MARAVIDA BRANDON MGT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 N PARSONS AVE
BRANDON FL
33510-3435
US

IV. Provider business mailing address

824 N PARSONS AVE
BRANDON FL
33510-3435
US

V. Phone/Fax

Practice location:
  • Phone: 813-413-6924
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ROBERTO CAREBETTA
Title or Position: MANAGING MEMBER
Credential:
Phone: 786-848-4414