1265420541 NPI number — V.J. DILELLA, D.O., L.L.C.

Table of content: (NPI 1265420541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265420541 NPI number — V.J. DILELLA, D.O., L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
V.J. DILELLA, D.O., L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265420541
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
703 VIRGINIA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUNEDIN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34698-6615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-734-4000
Provider Business Mailing Address Fax Number:
727-738-5037

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
703 VIRGINIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNEDIN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34698-6615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-734-4000
Provider Business Practice Location Address Fax Number:
727-738-5037
Provider Enumeration Date:
10/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DILELLA
Authorized Official First Name:
VINCENT
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
727-734-4000

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  OS0006347 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 21762 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 268202800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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