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General NPI Number Information
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NPI Number | 1477201804
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Entity Type | Organization
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Legal Business Name | DE LA SELVA FIRST ASSIST,LLC
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Dates
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Enumeration Date | 03/15/2022
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Last Update Date | 03/15/2022
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Provider Practice Location Address
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Address Line | 4611 N FEDERAL HWY APT 221
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City | POMPANO BEACH
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State | FL
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Zip | 33064-6669
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Country | US
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Telephone | 210-685-7023
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Fax |
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Provider Business Mailing Address
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Address Line | 4611 N FEDERAL HWY APT 221
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City | POMPANO BEACH
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State | FL
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Zip | 33064-6669
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Country | US
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Telephone | 210-685-7023
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Fax |
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Authorized Official
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Title or Position | CSFA
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Name | ANNA DE LA SELVA MCMILLIAN
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Credential | CSFA
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Telephone | 210-685-7023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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