Healthcare Provider Details

I. General information

NPI: 1508970989
Provider Name (Legal Business Name): RITA GARULLI CHIDIAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E SAMPLE RD STE 103
DEERFIELD BEACH FL
33064-4443
US

IV. Provider business mailing address

3700 NE 31ST AVE
LIGHTHOUSE POINT FL
33064-8431
US

V. Phone/Fax

Practice location:
  • Phone: 954-812-0043
  • Fax: 954-366-6851
Mailing address:
  • Phone: 954-812-0043
  • Fax: 954-366-6851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License NumberME43375
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: