Healthcare Provider Details

I. General information

NPI: 1598896136
Provider Name (Legal Business Name): ROMUALD DANGERVIL RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ANNE ROSE JEANNOT

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 NE 174TH ST
NORTH MIAMI BEACH FL
33162-1439
US

IV. Provider business mailing address

1630 NE 174TH ST
NORTH MIAMI BEACH FL
33162-1439
US

V. Phone/Fax

Practice location:
  • Phone: 786-417-3957
  • Fax: 305-940-3829
Mailing address:
  • Phone: 786-417-3957
  • Fax: 305-940-3829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT6258
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: