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General NPI Number Information
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NPI Number | 1902076821
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Entity Type | Individual
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Provider Name | ANDREW DATTILA D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/06/2008
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Last Update Date | 07/01/2021
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Provider Practice Location Address
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Address Line | 9380 SUNSET DR STE B245
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City | MIAMI
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State | FL
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Zip | 33173-5466
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Country | US
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Telephone | 305-223-0570
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Fax |
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Provider Business Mailing Address
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Address Line | 9380 SW 72ND ST STE B245
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City | MIAMI
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State | FL
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Zip | 33173-5466
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Country | US
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Telephone | 305-223-0570
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Fax | 305-223-0580
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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 | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS17186
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License Number State | FL
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