Provider Demographics
NPI:1700857406
Name:VINARUB, RISA L (DPM)
Entity Type:Individual
Prefix:DR
First Name:RISA
Middle Name:L
Last Name:VINARUB
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 N COURTENAY PKWY
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-5500
Mailing Address - Country:US
Mailing Address - Phone:321-452-5133
Mailing Address - Fax:321-449-8713
Practice Address - Street 1:1205 N COURTENAY PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-5500
Practice Address - Country:US
Practice Address - Phone:321-452-5133
Practice Address - Fax:321-449-8713
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2414213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL480027718OtherMEDICARE RAILROAD
FL65393OtherBLUE CROSS BLUE SHEILD
FLU55705Medicare UPIN
FL480027718OtherMEDICARE RAILROAD