Healthcare Provider Details

I. General information

NPI: 1245653781
Provider Name (Legal Business Name): TEST FIRST PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 YAMATO RD STE 1100
BOCA RATON FL
33431-4901
US

IV. Provider business mailing address

301 YAMATO RD STE 1100
BOCA RATON FL
33431-4901
US

V. Phone/Fax

Practice location:
  • Phone: 855-200-8262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number107377
License Number StateFL

VIII. Authorized Official

Name: BRAD ARTEL
Title or Position: OWNER
Credential: MD
Phone: 855-200-8262