MEDICARE: VICTOR ASTUDILLO CSA

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	363AS0400X	Surgical Physician Assistant	8233866723020	FL

General Provider Information

NPI Number	:	1700056801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR ASTUDILLO CSA

Provider Business Mailing Address
First Line	:	6420 64TH WAY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-7148
Country	:	US
Telephone Number	:	770-985-4257
Fax Number	:	770-985-4258

Provider Business Practice Location Address
First Line	:	6420 64TH WAY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-7148
Country	:	US
Telephone Number	:	770-985-4257
Fax Number	:	770-985-4258

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

Provider Enumeration Date	:	03/04/2008
Last Update Date	:	03/04/2008

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