Healthcare Provider Details

I. General information

NPI: 1003381617
Provider Name (Legal Business Name): CAROLINA PIZANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2018
Last Update Date: 10/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 COMMERCIAL CT STE C
VENICE FL
34292-1655
US

IV. Provider business mailing address

10014 N DALE MABRY HWY STE C-100
TAMPA FL
33618-4426
US

V. Phone/Fax

Practice location:
  • Phone: 800-356-4049
  • Fax: 800-895-0648
Mailing address:
  • Phone: 800-356-4049
  • Fax: 800-892-0648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: