Organization · NPI-2

Marcello A Borzatta MD PA

· Crestview, FL

NPI number1609090158
StatusActive
Last updated in NPPESMay 24, 2024

Details

NPI
1609090158
Entity type
Organization (NPI-2)
Legal business name
Marcello A Borzatta MD PA
Organization subpart
No
Enumeration date
Apr 13, 2007
Certification date
May 24, 2024
Last updated
May 24, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2086S0129X ––Yes

Practice location

435 Brookmeade Dr
Crestview, FL 32539-7304

Phone 850-305-2105 · Fax 239-663-3061

Mailing address

2260 S Ferdon Blvd
Crestview, FL 32536-8457

Phone 850-305-2105 · Fax 239-663-3061

Authorized official

Marcello A Borzatta
President
8508491642

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