Provider Demographics
NPI:1134504251
Name:SOUTH FLORIDA SURGICAL SPECIALTIES LLC
Entity Type:Organization
Organization Name:SOUTH FLORIDA SURGICAL SPECIALTIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXEI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-510-0990
Mailing Address - Street 1:831 CORAL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-4180
Mailing Address - Country:US
Mailing Address - Phone:954-510-0990
Mailing Address - Fax:
Practice Address - Street 1:831 CORAL RIDGE DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-4180
Practice Address - Country:US
Practice Address - Phone:954-510-0990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center