Provider Demographics
NPI:1437432960
Name:FATATO, VIRGINIA A (DC)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:A
Last Name:FATATO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W 24TH ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-4609
Mailing Address - Country:US
Mailing Address - Phone:305-771-3386
Mailing Address - Fax:
Practice Address - Street 1:255 W 24TH ST
Practice Address - Street 2:SUITE 108
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-4609
Practice Address - Country:US
Practice Address - Phone:305-771-3386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5536111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor