Healthcare Provider Details

I. General information

NPI: 1255486494
Provider Name (Legal Business Name): AMBULATORY SURGERY CENTER OF BOCA RATON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 CLINTMOORE ROAD SUITE 300
BOCA RATON FL
33496
US

IV. Provider business mailing address

1905 CLINTMOORE ROAD SUITE 300
BOCA RATON FL
33496
US

V. Phone/Fax

Practice location:
  • Phone: 561-544-5501
  • Fax: 561-544-5528
Mailing address:
  • Phone: 561-544-5501
  • Fax: 561-544-5528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MANISH GUPTA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 561-544-5501