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General NPI Number Information
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NPI Number | 1144910423
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Entity Type | Organization
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Legal Business Name | COASTAL SURGICAL SERVICES LLC
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Dates
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Enumeration Date | 05/10/2023
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Last Update Date | 05/10/2023
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Provider Practice Location Address
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Address Line | 48 FORT ROYAL IS
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City | FT LAUDERDALE
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State | FL
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Zip | 33308-6014
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Country | US
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Telephone | 321-626-9794
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Fax |
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Provider Business Mailing Address
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Address Line | 48 FORT ROYAL IS
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City | FT LAUDERDALE
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State | FL
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Zip | 33308-6014
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Country | US
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Telephone | 321-626-9794
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. BRADFORD ANGIULLI
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Credential | PA-C
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Telephone | 321-626-9794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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