Healthcare Provider Details

I. General information

NPI: 1861186579
Provider Name (Legal Business Name): AQ SURGERY II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 N FLAGLER DR STE 7600
WEST PALM BEACH FL
33401-3419
US

IV. Provider business mailing address

1411 N FLAGLER DR STE 7600
WEST PALM BEACH FL
33401-3419
US

V. Phone/Fax

Practice location:
  • Phone: 561-202-1070
  • Fax: 531-202-1075
Mailing address:
  • Phone: 561-202-1070
  • Fax: 531-202-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ANASTASIYA QUIMBY
Title or Position: PRESIDENT PHYSICIAN
Credential: MD, DDS
Phone: 561-202-1070