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General NPI Number Information
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NPI Number | 1790043008
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Entity Type | Organization
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Legal Business Name | BAY AREA CONSORTIUM OF ANESTHESIA SERVICES OF FLORIDA, LLC
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Dates
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Enumeration Date | 04/25/2012
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Last Update Date | 04/25/2012
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Provider Practice Location Address
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Address Line | 1007 W COMMERCIAL BLVD
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-3107
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Country | US
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Telephone | 954-822-7328
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 16786
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City | WEST PALM BEACH
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State | FL
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Zip | 33416-6786
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Country | US
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Telephone | 954-822-7328
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | MISS MOHINI DEWKINANDAN
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Credential |
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Telephone | 954-822-7328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 111629
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License Number State | FL
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