Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 20A9582 | CA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | OS13249 | FL |
NPI | 1033201058 |
---|---|
Provider Name | Dr. Carl P Dilella |
First Address | Vero Beach, FL 32960-6587 |
Second Address | Vero Beach, FL 32960-6587 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 15/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I07501 | (02) | IL |