Provider Demographics
NPI:1538227442
Name:CARIFI BREAST CARE PA
Entity type:Organization
Organization Name:CARIFI BREAST CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:G
Authorized Official - Last Name:CARIFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-421-7276
Mailing Address - Street 1:171 WEBB DRIVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837
Mailing Address - Country:US
Mailing Address - Phone:863-421-7276
Mailing Address - Fax:863-421-7109
Practice Address - Street 1:171 WEBB DRIVE
Practice Address - Street 2:SUITE #1
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837
Practice Address - Country:US
Practice Address - Phone:863-421-7276
Practice Address - Fax:863-421-7109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME30206208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53512OtherBLUE CROSS BLUE SHIELD
FL53512OtherBLUE CROSS BLUE SHIELD
FLD56557Medicare UPIN