Provider Demographics
NPI:1558767285
Name:URSO, VITO (MSOTRL)
Entity Type:Individual
Prefix:
First Name:VITO
Middle Name:
Last Name:URSO
Suffix:
Gender:M
Credentials:MSOTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 SW SUNSET TRL
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-3351
Mailing Address - Country:US
Mailing Address - Phone:772-559-7455
Mailing Address - Fax:
Practice Address - Street 1:1610 SW SUNSET TRL
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-3351
Practice Address - Country:US
Practice Address - Phone:772-559-7455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT15905174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist