=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215434592
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENNIS DARIO MD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2018
-----------------------------------------------------
Last Update Date | 04/12/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3633 LITTLE RD STE 104
-----------------------------------------------------
City | TRINITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34655-1815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-261-7009
-----------------------------------------------------
Fax | 727-261-7010
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3633 LITTLE RD STE 104
-----------------------------------------------------
City | TRINITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34655-1815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-261-7009
-----------------------------------------------------
Fax | 727-261-7010
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DENNIS DARIO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 813-401-7691
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------