Organization
NISSY SURGICAL 1ST ASSIST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RODRIGUE TERTUS (AUTHORIZED OFFICIAL)
(954) 416-1781
Entity
Organization
Contact information
Practice address
10752 EMILIA ISLES TER, BOYNTON BEACH, FL 33473-4965
(954) 416-1781
Mailing address
10752 EMILIA ISLES TER, BOYNTON BEACH, FL 33473-4965
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9107169
FL
Other
Enumeration date
12/29/2015
Last updated
12/29/2015
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