Healthcare Provider Details

I. General information

NPI: 1699494989
Provider Name (Legal Business Name): DAVARIUS BARGNARE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7041 GRAND NATIONAL DR
ORLANDO FL
32819-8381
US

IV. Provider business mailing address

1762 MORNING SKY DR
WINTER GARDEN FL
34787-5339
US

V. Phone/Fax

Practice location:
  • Phone: 407-982-7718
  • Fax:
Mailing address:
  • Phone: 407-953-8560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: