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Organization
TREASURE COAST COSMETIC SURGERY CENTER
Active
Organization
TREASURE COAST COSMETIC SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONATO ANTHONY VIGGIANO M.D. (MEDICAL DIRECTOR)
(772) 335-7477
Entity
Organization
Contact information
Practice address
1901 SE PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34952-5582
(772) 335-7477
(772) 335-8379
Mailing address
1901 SE PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34952-5582
(772) 335-7477
(772) 335-8379
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
741
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
667
BCBS PROVIDER NUMBER
FL
01
—
AS0000349
WORKERS COMP
FL
Enumeration date
07/15/2006
Last updated
08/22/2020
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