Healthcare Provider Details

I. General information

NPI: 1902354483
Provider Name (Legal Business Name): INDEPENDENCE TECHNICAL SERVICES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 WEST PALMETTO PARK RD STE 205
BOCA RATON FL
33433
US

IV. Provider business mailing address

7000 WEST PALMETTO PARK RD STE 205
BOCA RATON FL
33433
US

V. Phone/Fax

Practice location:
  • Phone: 855-200-8262
  • Fax: 561-584-5849
Mailing address:
  • Phone: 855-200-8262
  • Fax: 561-584-5849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD453599
License Number StatePA

VIII. Authorized Official

Name: AMJAD SAFVI
Title or Position: MEDICAL DOCTOR
Credential: M.D
Phone: 855-200-8262