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General NPI Number Information
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NPI Number | 1467753863
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Entity Type | Organization
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Legal Business Name | COMPLETE SURGICAL SERVICES, INC.
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Dates
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Enumeration Date | 11/16/2010
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Last Update Date | 11/16/2010
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Provider Practice Location Address
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Address Line | 261 W 32ND ST
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City | HIALEAH
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State | FL
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Zip | 33012-5317
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Country | US
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Telephone | 305-528-0447
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Fax | 305-463-6693
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Provider Business Mailing Address
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Address Line | 261 W 32ND ST
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City | HIALEAH
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State | FL
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Zip | 33012-5317
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Country | US
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Telephone | 305-528-0447
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Fax | 305-463-6693
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Authorized Official
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Title or Position | PRESIDENT
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Name | LIDICE B LOPEZ
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Credential | P.A.
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Telephone | 305-528-0447
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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 | PA 9104530
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License Number State | FL
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