Healthcare Provider Details

I. General information

NPI: 1780810408
Provider Name (Legal Business Name): LAUREANO A. CHILEUITT S.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4113 STAGHORN LN
WESTON FL
33331-3805
US

IV. Provider business mailing address

4113 STAGHORN LN
WESTON FL
33331-3805
US

V. Phone/Fax

Practice location:
  • Phone: 954-671-5800
  • Fax: 954-671-5800
Mailing address:
  • Phone: 954-671-5800
  • Fax: 954-671-5800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: