Healthcare Provider Details

I. General information

NPI: 1962649459
Provider Name (Legal Business Name): INTERNATIONAL SURGICAL TRAINING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4577 N NOB HILL RD. SUITE 207
SUNRISE FL
33351-4712
US

IV. Provider business mailing address

4577 N NOB HILL RD. SUITE 207
SUNRISE FL
33351-4712
US

V. Phone/Fax

Practice location:
  • Phone: 954-747-9670
  • Fax: 954-747-9673
Mailing address:
  • Phone: 954-747-9670
  • Fax: 954-747-9673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MRS. NORA MARVILLI
Title or Position: OWNER
Credential:
Phone: 954-747-9670