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General NPI Number Information
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NPI Number | 1760789242
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Entity Type | Organization
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Legal Business Name | SESAME FLYERS OF SOUTH FLORIDA INC.
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Dates
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Enumeration Date | 02/18/2011
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Last Update Date | 02/18/2011
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Provider Practice Location Address
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Address Line | 6781 NW 45TH ST
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City | LAUDERHILL
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State | FL
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Zip | 33319-4073
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Country | US
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Telephone | 954-274-7233
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Fax | 954-741-6902
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Provider Business Mailing Address
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Address Line | 6781 NW 45TH ST
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City | LAUDERHILL
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State | FL
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Zip | 33319-4073
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Country | US
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Telephone | 954-274-7233
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Fax | 954-741-6902
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. ANDY HENDERSON ANSOLA
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Credential |
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Telephone | 954-274-7233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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