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General NPI Number Information
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NPI Number | 1467796797
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Entity Type | Organization
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Legal Business Name | JUPITER HAND TO SHOULDER, LLC
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Dates
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Enumeration Date | 11/27/2012
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Last Update Date | 07/16/2018
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Provider Practice Location Address
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Address Line | 1002 S OLD DIXIE HWY SUITE 105
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City | JUPITER
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State | FL
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Zip | 33458
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Country | US
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Telephone | 561-746-7686
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Fax | 561-746-3420
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Provider Business Mailing Address
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Address Line | 1002 S OLD DIXIE HWY SUITE 105
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City | JUPITER
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State | FL
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Zip | 33458-7202
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Country | US
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Telephone | 561-746-7686
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Fax | 561-746-3420
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Authorized Official
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Title or Position | OWNER
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Name | VERONICA ASELA DIAZ
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Credential | MD
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Telephone | 561-746-7686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0105X
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Taxonomy Name | Surgery of the Hand (Surgery) Physician
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License Number | ME104238
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License Number State | FL
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