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General NPI Number Information
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NPI Number | 1972863298
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Entity Type | Organization
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Legal Business Name | INTERACTIVE MED-UNLIM SURG ASSIST
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Dates
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Enumeration Date | 05/21/2012
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Last Update Date | 05/21/2012
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Provider Practice Location Address
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Address Line | 49 N FEDERAL HWY SUITE 361
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City | POMPANO BEACH
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State | FL
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Zip | 33062-4304
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Country | US
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Telephone | 954-990-3515
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Fax |
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Provider Business Mailing Address
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Address Line | 49 N FEDERAL HWY SUITE 361
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City | POMPANO BEACH
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State | FL
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Zip | 33062-4304
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Country | US
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Telephone | 954-990-3515
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MIGUEL A ORTIZ-DIAZ
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Credential | PAC
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Telephone | 954-990-3515
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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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