Provider Demographics
NPI:1376122556
Name:FLORIDA CV ALLIANCE LLC
Entity Type:Organization
Organization Name:FLORIDA CV ALLIANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINOD
Authorized Official - Middle Name:
Authorized Official - Last Name:RAXWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-255-0920
Mailing Address - Street 1:14100 FIVAY RD STE 130
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7159
Mailing Address - Country:US
Mailing Address - Phone:727-255-0920
Mailing Address - Fax:727-255-5560
Practice Address - Street 1:14100 FIVAY RD STE 130
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7159
Practice Address - Country:US
Practice Address - Phone:727-255-0920
Practice Address - Fax:727-255-5560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000278100Medicaid