Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CH005969 | FL |
NPI | 1225192057 |
---|---|
Provider Name | Dr. Robert J Decubellis |
First Address | Sarasota, FL 34239-6413 |
Second Address | Sarasota, FL 34239-6413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 16/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U12403 | (02) | FL |