| Vicioso Medical And Addiction Services Llc | |
|
7261 Sheridan St Ste 100d Hollywood FL 33024-2708 | |
| (954) 534-7696 | |
| Not Available |
| Full Name | Vicioso Medical And Addiction Services Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 7261 Sheridan St Ste 100d, Hollywood, Florida |
| Authorized Official Name and Position | Luis E Vicioso (MGR) |
| Authorized Official Contact | 6468085915 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vicioso Medical And Addiction Services Llc 5729 Live Oak Ter Fort Lauderdale FL 33312-6377 Ph: (646) 808-5915 | Vicioso Medical And Addiction Services Llc 7261 Sheridan St Ste 100d Hollywood FL 33024-2708 Ph: (954) 534-7696 |
| NPI Number | 1861988016 |
|---|---|
| Provider Enumeration Date | 07/10/2018 |
| Last Update Date | 07/10/2018 |
| Medicare PECOS PAC ID | 8022341916 |
|---|---|
| Medicare Enrollment ID | O20190607001515 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861988016 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Chancilene Colas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770886095 PECOS PAC ID: 0547424640 Enrollment ID: I20120620000614 |
| Provider Name | Luis E Vicioso Peralta |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831356724 PECOS PAC ID: 3274677158 Enrollment ID: I20130716000610 |
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