Healthcare Provider Details

I. General information

NPI: 1730820051
Provider Name (Legal Business Name): CRISBEL ROSABAL PERNAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2022
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5286 GOLDEN GATE PKWY STE 1
NAPLES FL
34116-7650
US

IV. Provider business mailing address

5286 GOLDEN GATE PKWY STE 1
NAPLES FL
34116-7650
US

V. Phone/Fax

Practice location:
  • Phone: 239-427-0931
  • Fax: 754-222-6417
Mailing address:
  • Phone: 239-427-0931
  • Fax: 754-222-6417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1609
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: