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General NPI Number Information
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NPI Number | 1518315860
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Entity Type | Organization
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Legal Business Name | CRITICALNEEDMEDICINE HEALTHYFAMILY HEALTHYCOMMUNITY
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Dates
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Enumeration Date | 05/26/2016
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Last Update Date | 05/26/2016
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Provider Practice Location Address
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Address Line | 4910 14TH ST W SUITE 208
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City | BRADENTON
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State | FL
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Zip | 34207-2482
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Country | US
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Telephone | 941-755-7700
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Fax | 941-755-8100
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Provider Business Mailing Address
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Address Line | 4910 14TH ST W SUITE 208
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City | BRADENTON
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State | FL
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Zip | 34207-2482
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Country | US
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Telephone | 941-755-7700
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Fax | 941-755-8100
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. RICARDO GASPARD
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Credential | M.D.
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Telephone | 941-755-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ACN472
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License Number State | FL
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