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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