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General NPI Number Information
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NPI Number | 1750167326
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Entity Type | Organization
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Legal Business Name | ANDEAN GERIATRIC SERVICES LLC
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Dates
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Enumeration Date | 09/07/2023
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 13770 58TH ST N STE 308
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City | CLEARWATER
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State | FL
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Zip | 33760-3759
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Country | US
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Telephone | 727-262-1212
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Fax | 727-324-6902
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Provider Business Mailing Address
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Address Line | 13770 58TH ST N STE 308
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City | CLEARWATER
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State | FL
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Zip | 33760-3759
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Country | US
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Telephone | 727-262-1212
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Fax | 727-324-6902
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Authorized Official
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Title or Position | OWNER
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Name | FLAVIO VIVAS
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Credential |
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Telephone | 727-262-1212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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