Healthcare Provider Details

I. General information

NPI: 1578515995
Provider Name (Legal Business Name): RAND SURGICAL PAVILLION CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 W SAMPLE RD
DEERFIELD BEACH FL
33064-3542
US

IV. Provider business mailing address

5 W SAMPLE RD
POMPANO BEACH FL
33064-3542
US

V. Phone/Fax

Practice location:
  • Phone: 954-782-1700
  • Fax: 954-782-3432
Mailing address:
  • Phone: 954-782-1700
  • Fax: 954-782-3432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number794
License Number StateFL

VIII. Authorized Official

Name: DEBORAH G RAND
Title or Position: ADMINISTRATOR
Credential:
Phone: 954-782-1700