Doctor Name: | RICARDO BORNACELLI |
NPI Number: | 1679760383 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | TRN8248 |
Business Practice Address: | 12511 World Plaza Ln Building 50 Fort Myers, FL - 339073991 |
Business Phone Number: | 2399392622 |
Business Fax Number: | |
Mailing Address: | 12511 World Plaza Ln, Building 50 FORT MYERS |
State: | FL |
Postal Code: | 339073991 |
Phone Number: | 2399392622 |
Fax Number: | |
NPI Enumeration Date: | 09/26/2007 |
NPI Last Update Date: | 02/26/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | TRN8248 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |