Healthcare Provider Details

I. General information

NPI: 1730852708
Provider Name (Legal Business Name): ATISSO MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2331 N STATE ROAD 7 STE 220
LAUDERDALE LAKES FL
33313-3772
US

IV. Provider business mailing address

2331 N STATE ROAD 7 STE 220
LAUDERDALE LAKES FL
33313-3772
US

V. Phone/Fax

Practice location:
  • Phone: 954-290-9159
  • Fax: 954-206-0561
Mailing address:
  • Phone: 954-290-9159
  • Fax: 954-206-0561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. FRANTZ SAINVIL
Title or Position: PRESIDENT AND CO-OWNER
Credential: MD, PH.D.
Phone: 954-290-9159