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General NPI Number Information
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NPI Number | 1154519791
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Entity Type | Organization
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Legal Business Name | VICENTE C FLORIDA MD PA
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 11/02/2007
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Provider Practice Location Address
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Address Line | 1309 GARDEN ST
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City | TITUSVILLE
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State | FL
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Zip | 32796-2548
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Country | US
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Telephone | 321-267-4700
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Fax | 321-747-0347
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Provider Business Mailing Address
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Address Line | PO BOX 339
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City | TITUSVILLE
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State | FL
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Zip | 32781-0339
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Country | US
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Telephone | 321-267-4700
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Fax | 321-747-0347
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. VICENTE C FLORIDA III
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Credential | MD
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Telephone | 321-267-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0071351
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License Number State | FL
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