Galiano-Cevallos, Mario Ivan

Galiano-Cevallos, Mario Ivan is an individual health care provider with primary practice located at 4469 S Congress Ave Ste 106 , Lake Worth FL 33461-4726. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Galiano-Cevallos, Mario Ivan can be contacted via phone (561) 642-0768.

Contact Information

Primary practice address
4469 S Congress Ave Ste 106 Lake Worth FL 33461-4726
Phone: (561) 642-0768
Fax: (561) 642-0769
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA9100820 Florida

Profile Details

NPI number 1710099213
LBN Legal business name Galiano-Cevallos, Mario Ivan
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 31st, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710099213 NPPES
Florida MEDICAID 291336400

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