Healthcare Provider Details

I. General information

NPI: 1497281158
Provider Name (Legal Business Name): FAMILY CHOICES CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 W. DR. MARTIN LUTHER KING JR. BLVD.
TAMPA FL
33614
US

IV. Provider business mailing address

4001 W. DR. MARTIN LUTHER KING JR. BLVD.
TAMPA FL
33614
US

V. Phone/Fax

Practice location:
  • Phone: 813-876-1605
  • Fax:
Mailing address:
  • Phone: 813-876-1605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: VIVIAM SIFONTES
Title or Position: CEO
Credential:
Phone: 813-876-1605