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General NPI Number Information
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NPI Number | 1336313758
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Entity Type | Organization
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Legal Business Name | MARK O. ASPERILLA M.D.P.A.
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 3300 TAMIAMI TRL STE.102A
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-8054
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Country | US
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Telephone | 941-624-4499
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Fax | 941-624-0212
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Provider Business Mailing Address
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Address Line | 3300 TAMIAMI TRL STE.102A
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-8054
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Country | US
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Telephone | 941-624-4499
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Fax | 941-624-0212
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Authorized Official
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Title or Position | PRESIDENT-OWNER
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Name | DR. MARK OLIVARES ASPERILLA
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Credential | M.D.
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Telephone | 941-624-4499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | ME0052172
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License Number State | FL
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