Healthcare Provider Details

I. General information

NPI: 1477590362
Provider Name (Legal Business Name): BREVARD HEALTHWORX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 N COURTENAY PKWY
MERRITT ISLAND FL
32953-5500
US

IV. Provider business mailing address

1205 N COURTENAY PKWY
MERRITT ISLAND FL
32953-5500
US

V. Phone/Fax

Practice location:
  • Phone: 321-452-5133
  • Fax: 321-449-8714
Mailing address:
  • Phone: 321-452-5133
  • Fax: 321-449-8714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. RISA L VINARUB
Title or Position: OWNER / MEDICAL DIRECTOR
Credential: DPM
Phone: 321-452-5133