=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922279389
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PALM BEACH OBSTETRICS & GYNECOLOGY, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2008
-----------------------------------------------------
Last Update Date | 04/03/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4671 S CONGRESS AVE SUITE 100B
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33461-4783
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-434-0111
-----------------------------------------------------
Fax | 561-296-3533
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4671 S CONGRESS AVE SUITE 100B
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33461-4783
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-434-0111
-----------------------------------------------------
Fax | 561-296-3533
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. VIVIAN VITERI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-434-0111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------