Healthcare Provider Details

I. General information

NPI: 1649706979
Provider Name (Legal Business Name): BAYSHORE SURGICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2017
Last Update Date: 05/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 CORAL WAY SUITE 302
CORAL GABLES FL
33145-3216
US

IV. Provider business mailing address

3181 CORAL WAY SUITE 302
CORAL GABLES FL
33145-3216
US

V. Phone/Fax

Practice location:
  • Phone: 305-856-1002
  • Fax: 877-501-4190
Mailing address:
  • Phone: 305-856-1002
  • Fax: 877-501-4190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JUAN CARLOS FLEITES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 305-856-1002