Healthcare Provider Details

I. General information

NPI: 1417108234
Provider Name (Legal Business Name): BEVERLY K DI GIORGI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LA FLORESTA 1000 CARR 831 APT 631
BAYAMON PR
00956
US

IV. Provider business mailing address

LA FLORESTA 1000 CARR 831 APT 631
BAYAMON PR
00956
US

V. Phone/Fax

Practice location:
  • Phone: 787-667-9153
  • Fax:
Mailing address:
  • Phone: 787-667-9153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18230
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number18230
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number18230
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License Number18230
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: