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General NPI Number Information
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NPI Number | 1790871424
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Entity Type | Organization
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Legal Business Name | TOTAL SENIOR HEALTH CARE MOBILE PHYSICIAN SERVICES LLC
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 01/13/2011
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Provider Practice Location Address
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Address Line | 3368 WOODS EDGE CIR SUITE 104
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-3437
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Country | US
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Telephone | 239-390-2032
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Fax |
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Provider Business Mailing Address
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Address Line | 3368 WOODS EDGE CIR SUITE 104
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-3437
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. DONALD JOHN DIPASCO
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Credential | M.D.
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Telephone | 239-390-2032
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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