Healthcare Provider Details

I. General information

NPI: 1114351079
Provider Name (Legal Business Name): VIP DOCTORS CARE OF ST AUGUSTINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 STATE ROAD 207 SUITE 102
ST AUGUSTINE FL
32084-5937
US

IV. Provider business mailing address

2301 NW 33RD CT SUITE 111
POMPANO BEACH FL
33069-1000
US

V. Phone/Fax

Practice location:
  • Phone: 561-843-7720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH DICAPUA
Title or Position: MANAGING MEMBER
Credential:
Phone: 561-843-7720