Organization
BLAIQ SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN DUHARTE (SURGICAL ASSISTANT CERTIFIED)
(916) 952-5532
Entity
Organization
Contact information
Practice address
4711 S INDIAN RIVER DR, FORT PIERCE, FL 34982-7769
(916) 952-5532
Mailing address
4711 S INDIAN RIVER DR, FORT PIERCE, FL 34982-7769
(916) 952-5532
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
—
—
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
04/18/2024
Last updated
04/20/2024
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