Healthcare Provider Details

I. General information

NPI: 1003168543
Provider Name (Legal Business Name): PAUL JOESPH DIGIROLAMO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2462 SE ROCK SPRINGS DR
PORT SAINT LUCIE FL
34952-7350
US

IV. Provider business mailing address

2462 SE ROCK SPRINGS DR
PORT SAINT LUCIE FL
34952-7350
US

V. Phone/Fax

Practice location:
  • Phone: 772-812-4284
  • Fax: 772-466-4448
Mailing address:
  • Phone: 772-812-4284
  • Fax: 772-466-4448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: