Healthcare Provider Details

I. General information

NPI: 1073299079
Provider Name (Legal Business Name): 4A SURGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12373 COLONY PRESERVE DR
BOYNTON BEACH FL
33436-5807
US

IV. Provider business mailing address

12373 COLONY PRESERVE DR
BOYNTON BEACH FL
33436-5807
US

V. Phone/Fax

Practice location:
  • Phone: 561-617-0686
  • Fax:
Mailing address:
  • Phone: 561-617-0686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: EDISSON GUAMAN
Title or Position: OWNER
Credential: PA
Phone: 561-617-0686