Provider Demographics
NPI:1417332982
Name:SW FLORIDA CARDIOVASCULAR INSTITUTE PLLC
Entity Type:Organization
Organization Name:SW FLORIDA CARDIOVASCULAR INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GONZALO
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARRIZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-833-4313
Mailing Address - Street 1:PO BOX 511446
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33951-1446
Mailing Address - Country:US
Mailing Address - Phone:941-833-4313
Mailing Address - Fax:941-347-8483
Practice Address - Street 1:6210 SCOTT ST
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3901
Practice Address - Country:US
Practice Address - Phone:941-833-4313
Practice Address - Fax:941-347-8483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103088208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty