ALLERGY & ASTHMA CARE CENTRE PA - NPI NUMBER 1780739946

Summary

Provider Name: ALLERGY & ASTHMA CARE CENTRE PA

NPI Number: 1780739946

Clasification: Allergy & Immunology (207KI0005X)

Specialization: Clinical & Laboratory Immunology

Address:
8461 CYPRESS LAKE DRIVE
FORT MYERS, FL
ZIP 33919

Phone Number: (239) 489-1398



Detailed Information

ALLERGY & ASTHMA CARE CENTRE PA is a clinical & laboratory immunology allergist in Fort Myers, FL. The assigned NPI number for this provider is 1780739946 and is registered as an organization entity type and is a single specialty group.

The provider's business address is:

8461 CYPRESS LAKE DRIVE
FORT MYERS, FL
ZIP 33919-187
Phone: (239) 489-1398
Fax: (239) 482-7881

The provider's authorized official is Lazaro Luis Castillo .
The authorized official title is PRESIDENT OWNEROwner and has the following contact phone number (239) 549-1398.

The enumeration date for this NPI number is 1/25/2007 and was last updated on 1/3/2008.

Map - Location of Practice





Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 207KI0005X Allergy & Immunology Clinical & Laboratory Immunology ME74018 FL Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 K1425GP MEDICARE PIN FL
2 F23902 MEDICARE UPIN FL

NPI Record

No. Field Name Field Value
1 NPI 1780739946
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name ALLERGY & ASTHMA CARE CENTRE PA
5 Provider First Line Business Practice Location Address 8461 CYPRESS LAKE DRIVE
6 Provider Business Practice Location Address City Name FORT MYERS
7 Provider Business Practice Location Address State Name FL
8 Provider Business Practice Location Address Postal Code 339195187
9 Provider Business Practice Location Address Country Code If outside U S US
10 Provider Business Practice Location Address Telephone Number 2394891398
11 Provider Business Practice Location Address Fax Number 2394827881
12 Provider Enumeration Date 1/25/2007
13 Last Update Date 1/3/2008
14 Authorized Official Last Name CASTILLO
15 Authorized Official First Name LAZARO
16 Authorized Official Middle Name LUIS
17 Authorized Official Title or Position PRESIDENT OWNER
18 Authorized Official Telephone Number 2395491398
19 Healthcare Provider Taxonomy Code 1 207KI0005X
20 Provider License Number 1 ME74018
21 Provider License Number State Code 1 FL
22 Healthcare Provider Primary Taxonomy Switch 1 Y
23 Other Provider Identifier 1 K1425GP
24 Other Provider Identifier Type Code 1 08
25 Other Provider Identifier State 1 FL
26 Other Provider Identifier 2 F23902
27 Other Provider Identifier Type Code 2 02
28 Other Provider Identifier State 2 FL
29 Is Organization Subpart N
30 Authorized Official Credential Text MD
31 Healthcare Provider Taxonomy Group 1 193400000X SINGLE SPECIALTY GROUP

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This page was last updated on: 10/12/2014
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