Provider Demographics
NPI:1053485391
Name:ANA LUISA T-Y SAFRA MD, LLC
Entity Type:Organization
Organization Name:ANA LUISA T-Y SAFRA MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SAFRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-313-4884
Mailing Address - Street 1:PO BOX 211237
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33421-1237
Mailing Address - Country:US
Mailing Address - Phone:561-313-4884
Mailing Address - Fax:561-784-7202
Practice Address - Street 1:13005 SOUTHERN BLVD
Practice Address - Street 2:SUITE 225
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9206
Practice Address - Country:US
Practice Address - Phone:561-313-4884
Practice Address - Fax:561-784-7202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K9531Medicare PIN