Healthcare Provider Details

I. General information

NPI: 1861438111
Provider Name (Legal Business Name): CHRISTOPHER DAGROSSA D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11220 NW 49TH ST
CORAL SPRINGS FL
33076-2771
US

IV. Provider business mailing address

11220 NW 49TH ST
CORAL SPRINGS FL
33076-2771
US

V. Phone/Fax

Practice location:
  • Phone: 954-741-1233
  • Fax: 954-344-7029
Mailing address:
  • Phone: 954-741-1233
  • Fax: 954-344-7029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO1976
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: