Provider Demographics
NPI:1063662989
Name:BREITWIESER, RAY MOND JOSEPH JR (RNFA)
Entity Type:Individual
Prefix:MR
First Name:RAY MOND
Middle Name:JOSEPH
Last Name:BREITWIESER
Suffix:JR
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3835 NW 72ND DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-2244
Mailing Address - Country:US
Mailing Address - Phone:954-341-6105
Mailing Address - Fax:
Practice Address - Street 1:3835 NW 72ND DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-2244
Practice Address - Country:US
Practice Address - Phone:954-341-6105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-27
Last Update Date:2008-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1930212163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant