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General NPI Number Information
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NPI Number | 1417267980
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Entity Type | Organization
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Legal Business Name | CVIO DIAGNOSTICS
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Dates
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Enumeration Date | 10/18/2010
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Last Update Date | 10/18/2010
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Provider Practice Location Address
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Address Line | 5540 E GRANT ST STE B
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City | ORLANDO
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State | FL
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Zip | 32822-1668
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Country | US
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Telephone | 407-480-4445
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Fax | 407-480-4446
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Provider Business Mailing Address
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Address Line | 5540 E GRANT ST STE B
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City | ORLANDO
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State | FL
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Zip | 32822-1668
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Country | US
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Telephone | 407-480-4445
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Fax | 407-480-4446
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | SUVARCHALA D DARA
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Credential | MD
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Telephone | 407-480-4445
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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 | ME105611
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License Number State | FL
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