Healthcare Provider Details

I. General information

NPI: 1033201058
Provider Name (Legal Business Name): CARL P DILELLA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 03/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 36TH ST STE 100
VERO BEACH FL
32960-6587
US

IV. Provider business mailing address

1285 36TH ST STE 100
VERO BEACH FL
32960-6587
US

V. Phone/Fax

Practice location:
  • Phone: 772-778-2009
  • Fax: 772-778-1895
Mailing address:
  • Phone: 772-778-2009
  • Fax: 772-778-1895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number20A9582
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberOS13249
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: