Healthcare Provider Details

I. General information

NPI: 1649516717
Provider Name (Legal Business Name): ORTHO FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 W 20TH AVE SUITE 209
HIALEAH FL
33016-5529
US

IV. Provider business mailing address

660 GLADES RD SUITE 460
BOCA RATON FL
33431-6465
US

V. Phone/Fax

Practice location:
  • Phone: 305-467-5678
  • Fax: 305-503-7006
Mailing address:
  • Phone: 561-300-1779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMDR-4545
License Number StateHI

VIII. Authorized Official

Name: JASON TOCCI
Title or Position: CEO
Credential:
Phone: 954-410-5194