Provider Demographics
NPI:1790334761
Name:SURGI-MED AND TECHNOLOGY DEVELOPMENT LLC
Entity Type:Organization
Organization Name:SURGI-MED AND TECHNOLOGY DEVELOPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:O
Authorized Official - Last Name:SEJAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-915-0659
Mailing Address - Street 1:1300 NE MIAMI GARDENS DR APT 301
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4730
Mailing Address - Country:US
Mailing Address - Phone:305-915-0659
Mailing Address - Fax:
Practice Address - Street 1:1300 NE MIAMI GARDENS DR APT 301
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-4730
Practice Address - Country:US
Practice Address - Phone:305-915-0659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-11
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty