MEDICARE: LIZBETH SUJEY VIZCARDO BULEJE SA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant	17-597	FL

General Provider Information

NPI Number	:	1013429604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIZBETH SUJEY VIZCARDO BULEJE SA-C

Provider Business Mailing Address
First Line	:	9000 ROYAL PALM BLVD APT 310
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-5855
Country	:	US
Telephone Number	:	954-696-8864
Fax Number	:

Provider Business Practice Location Address
First Line	:	9000 ROYAL PALM BLVD APT 310
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-5855
Country	:	US
Telephone Number	:	954-696-8864
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2017
Last Update Date	:	11/03/2017

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