Healthcare Provider Details

I. General information

NPI: 1215401237
Provider Name (Legal Business Name): SYLVIO ARCHIBAL RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2019
Last Update Date: 01/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4656 VILLAS SANTORINI DR
LAKE WORTH FL
33461-5098
US

IV. Provider business mailing address

PO BOX 541801
GREENACRES FL
33454-1801
US

V. Phone/Fax

Practice location:
  • Phone: 561-223-5511
  • Fax:
Mailing address:
  • Phone: 561-223-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT12805
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: