Provider Demographics
NPI:1194976126
Name:ENVITA FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:ENVITA FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANTO
Authorized Official - Middle Name:DINO
Authorized Official - Last Name:PRATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-694-8852
Mailing Address - Street 1:PO BOX 2065
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77252-2065
Mailing Address - Country:US
Mailing Address - Phone:800-785-8765
Mailing Address - Fax:281-453-1945
Practice Address - Street 1:8759 E BELL RD
Practice Address - Street 2:BLDG G
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1322
Practice Address - Country:US
Practice Address - Phone:602-569-4144
Practice Address - Fax:602-569-4244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center