Healthcare Provider Details

I. General information

NPI: 1538227442
Provider Name (Legal Business Name): CARIFI BREAST CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 WEBB DRIVE SUITE #1
DAVENPORT FL
33837
US

IV. Provider business mailing address

171 WEBB DRIVE SUITE #1
DAVENPORT FL
33837
US

V. Phone/Fax

Practice location:
  • Phone: 863-421-7276
  • Fax: 863-421-7109
Mailing address:
  • Phone: 863-421-7276
  • Fax: 863-421-7109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME30206
License Number StateFL

VIII. Authorized Official

Name: VINCENT G CARIFI
Title or Position: OWNER
Credential: M.D.
Phone: 863-421-7276