MEDICARE: ADVANCED SURGICAL & WEIGHT LOSS INSTITUTE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	ME 94651	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376965822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED SURGICAL & WEIGHT LOSS INSTITUTE LLC

Provider Business Mailing Address
First Line	:	3165 SUNTREE BLVD STE 101
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-5720
Country	:	US
Telephone Number	:	321-549-2000
Fax Number	:	321-549-2142

Provider Business Practice Location Address
First Line	:	3165 SUNTREE BLVD STE 101
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-5720
Country	:	US
Telephone Number	:	321-549-2000
Fax Number	:	321-549-2142

Authorized Official
Title or Position	:	OWNER
Name	:	DIEGO VELARDE
Credential	:	MD
Telephone Number	:	321-549-2000

Provider Enumeration Date	:	01/16/2014
Last Update Date	:	06/12/2024

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