Healthcare Provider Details

I. General information

NPI: 1588983787
Provider Name (Legal Business Name): FIRST ASSISTANT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 04/10/2021
Certification Date: 04/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19538 S WHITEWATER AVE
WESTON FL
33332-2444
US

IV. Provider business mailing address

19538 S WHITEWATER AVE
WESTON FL
33332-2444
US

V. Phone/Fax

Practice location:
  • Phone: 954-237-7728
  • Fax: 866-240-3482
Mailing address:
  • Phone: 954-237-7728
  • Fax: 866-240-3482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9101346
License Number StateFL

VIII. Authorized Official

Name: MR. NESTOR G VIA Y RADA
Title or Position: PRESIDENT
Credential: PA-C
Phone: 954-237-7728