Healthcare Provider Details

I. General information

NPI: 1922544741
Provider Name (Legal Business Name): RIVERVIEW PRIMARY CARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12967 US HIGHWAY 301 S
RIVERVIEW FL
33578-7647
US

IV. Provider business mailing address

12967 US HIGHWAY 301 S
RIVERVIEW FL
33578-7647
US

V. Phone/Fax

Practice location:
  • Phone: 813-443-6369
  • Fax: 813-280-2584
Mailing address:
  • Phone: 813-443-6369
  • Fax: 813-280-2584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME83175
License Number StateFL

VIII. Authorized Official

Name: PAUL M PULCINI
Title or Position: DOCTOR
Credential: M.D.
Phone: 813-269-6426