Healthcare Provider Details

I. General information

NPI: 1467262717
Provider Name (Legal Business Name): MEDASANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 CAMINO REAL STE 200
BOCA RATON FL
33433-5510
US

IV. Provider business mailing address

304 INDIAN TRCE # 976
WESTON FL
33326-2996
US

V. Phone/Fax

Practice location:
  • Phone: 754-200-1617
  • Fax: 954-656-0108
Mailing address:
  • Phone: 754-200-1617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SEGUNDO GONZALEZ
Title or Position: OFFICER
Credential: MD
Phone: 754-200-1617