Healthcare Provider Details

I. General information

NPI: 1255221586
Provider Name (Legal Business Name): PALM BEACH SURGICAL SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 VILLAGE BLVD STE 200
WEST PALM BEACH FL
33409-1963
US

IV. Provider business mailing address

5987 TIFFANY PL
WEST PALM BEACH FL
33417-4339
US

V. Phone/Fax

Practice location:
  • Phone: 561-694-6911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RAMON VAZQUEZ
Title or Position: OWNER
Credential:
Phone: 561-234-0394