Organization
FAGVA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSTAM BAKHATIIAROV (PRESIDENT)
(305) 615-9294
Entity
Organization
Contact information
Practice address
1305 NE 4TH CT, BOCA RATON, FL 33432-2811
(305) 615-9294
Mailing address
1305 NE 4TH CT, BOCA RATON, FL 33432-2811
(305) 615-9294
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
10/01/2025
Last updated
10/01/2025
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