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General NPI Number Information
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NPI Number | 1871834978
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Entity Type | Organization
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Legal Business Name | BOCA RATON SURGICAL ASSIST PA
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Dates
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Enumeration Date | 03/14/2013
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Last Update Date | 03/14/2013
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Provider Practice Location Address
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Address Line | 582 NW 12TH TER
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City | BOCA RATON
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State | FL
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Zip | 33486-3262
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Country | US
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Telephone | 561-654-5013
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Fax |
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Provider Business Mailing Address
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Address Line | 9858 CLINT MOORE RD C111-274
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City | BOCA RATON
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State | FL
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Zip | 33496-1034
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Country | US
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Telephone | 561-482-1144
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Fax | 561-482-1145
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT A MILBUT JR.
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Credential | RNFA
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Telephone | 561-654-5013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | 2158742
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License Number State | FL
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