Healthcare Provider Details

I. General information

NPI: 1679125215
Provider Name (Legal Business Name): MR. CARL BRESCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2019
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S STATE ROAD 7 STE 112
WELLINGTON FL
33414-4304
US

IV. Provider business mailing address

3365 BURNS RD STE 203
PALM BEACH GARDENS FL
33410-4303
US

V. Phone/Fax

Practice location:
  • Phone: 561-402-3971
  • Fax:
Mailing address:
  • Phone: 561-402-3971
  • Fax: 561-422-4799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9114903
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number025724
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: