Healthcare Provider Details

I. General information

NPI: 1780246207
Provider Name (Legal Business Name): SARA RIFAI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2019
Last Update Date: 07/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4675 E SR 44 STE 104
WILDWOOD FL
34785-7461
US

IV. Provider business mailing address

3585 SW 38TH TER UNIT J202
OCALA FL
34474-5826
US

V. Phone/Fax

Practice location:
  • Phone: 352-418-3041
  • Fax:
Mailing address:
  • Phone: 407-928-6744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number24160
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: