Provider Demographics
NPI:1679723431
Name:VERSSA WOMENS CENTER PA
Entity Type:Organization
Organization Name:VERSSA WOMENS CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOCAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-437-4808
Mailing Address - Street 1:36739 STATE ROAD 52
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-5101
Mailing Address - Country:US
Mailing Address - Phone:352-437-4808
Mailing Address - Fax:352-437-4811
Practice Address - Street 1:36739 STATE ROAD 52
Practice Address - Street 2:SUITE 101
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-5101
Practice Address - Country:US
Practice Address - Phone:352-437-4808
Practice Address - Fax:352-437-4811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102660207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty