MEDICARE: DR. DIEGO ITZJAK SHMUELS SURGICAL ASSISTANT

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	07286	FL

General Provider Information

NPI Number	:	1548425424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIEGO ITZJAK SHMUELS SURGICAL ASSISTANT

Provider Business Mailing Address
First Line	:	7521 W TREASURE DR
Second Line	:
City	:	NORTH BAY VILLAGE
State	:	FL
Zip	:	33141-4117
Country	:	US
Telephone Number	:	305-505-2013
Fax Number	:	305-868-2343

Provider Business Practice Location Address
First Line	:	7521 W TREASURE DR
Second Line	:
City	:	NORTH BAY VILLAGE
State	:	FL
Zip	:	33141-4117
Country	:	US
Telephone Number	:	305-505-2013
Fax Number	:	305-868-2343

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

Provider Enumeration Date	:	07/21/2008
Last Update Date	:	07/21/2008

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