Healthcare Provider Details

I. General information

NPI: 1457822645
Provider Name (Legal Business Name): RODOLFO RAFAEL VITON APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 N FLAGLER DR
WEST PALM BEACH FL
33401-3406
US

IV. Provider business mailing address

141 EXECUTIVE CIR
BOYNTON BEACH FL
33436-1835
US

V. Phone/Fax

Practice location:
  • Phone: 561-882-4541
  • Fax:
Mailing address:
  • Phone: 561-436-7160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11000156
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: