Individual
FANIE AUGUSTAMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8632 NW 34TH PL APT C102, SUNRISE, FL 33351-6652
(954) 245-2401
Mailing address
8632 NW 34TH PL APT C102, SUNRISE, FL 33351-6652
(954) 245-2401
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
04/06/2017
Last updated
04/06/2017
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