Provider Demographics
NPI:1508970989
Name:GARULLI CHIDIAC, RITA
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:GARULLI CHIDIAC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 NE 36TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-7574
Mailing Address - Country:US
Mailing Address - Phone:954-782-9771
Mailing Address - Fax:954-946-9138
Practice Address - Street 1:2100 NE 36TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-7574
Practice Address - Country:US
Practice Address - Phone:954-782-9771
Practice Address - Fax:954-946-9138
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43375207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046637900Medicaid
FL94505Medicare ID - Type Unspecified
FLE14942Medicare UPIN