Healthcare Provider Details

I. General information

NPI: 1538755046
Provider Name (Legal Business Name): CENTER FOR JOINT HEALTH, PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2020
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10420 S US 301 STE 2
RIVERVIEW FL
33578-5806
US

IV. Provider business mailing address

10232 BRIGHT CRYSTAL AVE
RIVERVIEW FL
33578-4287
US

V. Phone/Fax

Practice location:
  • Phone: 412-801-2236
  • Fax: 813-274-1946
Mailing address:
  • Phone: 412-801-2236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DARREN FARNESI
Title or Position: PRESIDENT
Credential: MD
Phone: 619-857-9747