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General NPI Number Information
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NPI Number | 1659172724
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Entity Type | Organization
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Legal Business Name | CHARLES'S SURGICAL ASSISTANT GROUP LLC
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 335 NW 34TH ST APT 203
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City | POMPANO BEACH
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State | FL
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Zip | 33064-2820
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Country | US
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Telephone | 954-451-8504
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Fax |
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Provider Business Mailing Address
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Address Line | 335 NW 34TH ST APT 203
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City | POMPANO BEACH
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State | FL
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Zip | 33064-2820
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Country | US
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Telephone | 954-451-8504
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | NONO CHARLES
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Credential | PA, SA-C
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Telephone | 954-451-8504
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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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