Healthcare Provider Details

I. General information

NPI: 1912250515
Provider Name (Legal Business Name): SURGICAL ASSISTANT INNOVATIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2012
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 INTEGRA SHORE DR UNIT 305
DAYTONA BEACH FL
32117
US

IV. Provider business mailing address

132 INTEGRA SHORE DR UNIT 305
DAYTONA BEACH FL
32117-5567
US

V. Phone/Fax

Practice location:
  • Phone: 708-790-7333
  • Fax:
Mailing address:
  • Phone: 708-790-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number2560202
License Number StateFL

VIII. Authorized Official

Name: MR. DALE VLADIC
Title or Position: PRESIDENT/CEO
Credential: CRNFA
Phone: 708-790-7333