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General NPI Number Information
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NPI Number | 1710513056
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Entity Type | Organization
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Legal Business Name | WEST PALM BEACH SURGICAL ASSISTING LLC
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Dates
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Enumeration Date | 03/18/2020
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Last Update Date | 05/17/2020
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Provider Practice Location Address
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Address Line | 10628 PASO FINO DR
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City | LAKE WORTH
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State | FL
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Zip | 33449-8018
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Country | US
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Telephone | 561-631-8171
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Fax | 561-631-8171
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Provider Business Mailing Address
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Address Line | PO BOX 210241
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City | ROYAL PALM BEACH
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State | FL
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Zip | 33421-0241
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SA-C
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Name | MR. JOHN SANTORO
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Credential |
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Telephone | 561-631-8171
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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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