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General NPI Number Information
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NPI Number | 1730304221
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Entity Type | Individual
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Provider Name | MARIO NOEL FAVILLI M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 03/06/2008
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Provider Practice Location Address
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Address Line | 4855 W HILLSBORO BLVD B8
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City | COCONUT CREEK
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State | FL
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Zip | 33073-4356
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Country | US
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Telephone | 954-481-2278
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Fax | 954-481-1987
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Provider Business Mailing Address
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Address Line | 4855 W HILLSBORO BLVD SUITE B8
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City | COCONUT CREEK
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State | FL
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Zip | 33073-4356
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Country | US
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Telephone | 954-481-2278
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME0050696
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License Number State | FL
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