Healthcare Provider Details

I. General information

NPI: 1639336605
Provider Name (Legal Business Name): PATRIZIA F CIUFO-LOPEZ OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3975 VILLAGE DR UNIT D
DELRAY BEACH FL
33445-2961
US

IV. Provider business mailing address

3975 VILLAGE DR UNIT D
DELRAY BEACH FL
33445-2961
US

V. Phone/Fax

Practice location:
  • Phone: 561-900-6254
  • Fax: 561-498-0733
Mailing address:
  • Phone: 561-900-6254
  • Fax: 561-498-0733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberOT6885
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: