Healthcare Provider Details

I. General information

NPI: 1699864579
Provider Name (Legal Business Name): PROFESSIONAL SURGICAL ASSISTANTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 06/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7770 HAWTHORNE AVE
MIAMI BEACH FL
33141-1038
US

IV. Provider business mailing address

7770 HAWTHORNE AVE
MIAMI BEACH FL
33141-1038
US

V. Phone/Fax

Practice location:
  • Phone: 305-968-1829
  • Fax: 305-866-2486
Mailing address:
  • Phone: 305-968-1829
  • Fax: 305-866-2486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. MIGUEL P LETOURNEAUT
Title or Position: PRESIDENT
Credential: P.A.
Phone: 305-968-1829