Healthcare Provider Details

I. General information

NPI: 1780201681
Provider Name (Legal Business Name): CAIO FABIO NOCITI FREITAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 FOWLER GROVE BLVD STE 220
WINTER GARDEN FL
34787-5597
US

IV. Provider business mailing address

2200 FOWLER GROVE BLVD STE 220
WINTER GARDEN FL
34787-5597
US

V. Phone/Fax

Practice location:
  • Phone: 407-656-0042
  • Fax:
Mailing address:
  • Phone: 407-656-0042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN31700
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: