# BLAIQ SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982459434
- **Authorized official:** JUSTIN DUHARTE (SURGICAL ASSISTANT CERTIFIED)
- **Authorized official phone:** (916) 952-5532

## Contact information

- **Practice address:** 4711 S INDIAN RIVER DR, FORT PIERCE, FL 34982-7769
- **Practice address phone:** (916) 952-5532
- **Mailing address:** 4711 S INDIAN RIVER DR, FORT PIERCE, FL 34982-7769
- **Mailing address phone:** (916) 952-5532

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | — |
| 363AS0400X | Surgical Physician Assistant | — | NULL | Yes |
| 363AS0400X | Surgical Physician Assistant | — | — | Yes |

## Other

- **Enumeration date:** 04/18/2024
- **Last updated:** 04/20/2024