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General NPI Number Information
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NPI Number | 1255644969
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Entity Type | Organization
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Legal Business Name | FLORIDA ENDOVASCULAR SPECIALISTS LLC
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Dates
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Enumeration Date | 07/22/2010
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Last Update Date | 07/22/2010
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Provider Practice Location Address
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Address Line | 1890 LPGA BLVD SUITE 140
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-7130
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Country | US
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Telephone | 386-274-7250
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Fax | 386-274-7259
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Provider Business Mailing Address
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Address Line | 1673 MASON AVE SUITE 305
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5515
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Country | US
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Telephone | 386-274-7118
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Fax | 386-274-6173
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Authorized Official
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Title or Position | CEO
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Name | MR. AL FALCO
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Credential |
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Telephone | 386-274-7118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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