Healthcare Provider Details

I. General information

NPI: 1336665256
Provider Name (Legal Business Name): FARESI SURGICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2839 S SEACREST BLVD
BOYNTON BEACH FL
33435-7934
US

IV. Provider business mailing address

11766 FOXBRIAR LAKE TRL
BOYNTON BEACH FL
33473-7830
US

V. Phone/Fax

Practice location:
  • Phone: 561-732-2464
  • Fax:
Mailing address:
  • Phone: 606-465-4583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberME96085
License Number StateFL

VIII. Authorized Official

Name: MARIANO FARESI
Title or Position: MD
Credential: MD
Phone: 606-465-4583