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General NPI Number Information
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NPI Number | 1326286204
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Entity Type | Organization
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Legal Business Name | COSMETIC VEIN CLINIC OF FLORIDA INC
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Dates
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Enumeration Date | 01/30/2009
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Last Update Date | 02/25/2009
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Provider Practice Location Address
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Address Line | 2225 59TH ST W SUITE B
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City | BRADENTON
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State | FL
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Zip | 34209-7017
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Country | US
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Telephone | 941-761-1746
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Fax | 941-761-0188
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Provider Business Mailing Address
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Address Line | 2225 59TH ST W SUITE B
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City | BRADENTON
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State | FL
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Zip | 34209-7017
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Country | US
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Telephone | 941-761-1746
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Fax | 941-761-0188
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH P PECORARO
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Credential | MD
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Telephone | 941-761-1746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME59036
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License Number State | FL
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