=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376234807
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTEGRITY GERIATRICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2023
-----------------------------------------------------
Last Update Date | 05/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1333 3RD AVE S STE 506
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34102-6538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-304-8040
-----------------------------------------------------
Fax | 239-331-3859
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6696 MARBELLA LN
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34105-5030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-550-0646
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | CHARINA YANGO-CADAVOS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 816-550-0646
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------