Provider Demographics
NPI:1255409959
Name:VIA Y RADA, NESTOR G (PA-C)
Entity type:Individual
Prefix:
First Name:NESTOR
Middle Name:G
Last Name:VIA Y RADA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 JFK DR STE 320
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6641
Mailing Address - Country:US
Mailing Address - Phone:561-548-4900
Mailing Address - Fax:561-434-5165
Practice Address - Street 1:180 JFK DR STE 320
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6641
Practice Address - Country:US
Practice Address - Phone:561-548-4900
Practice Address - Fax:561-434-5165
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101346363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9101346OtherLICENSE
FLE5002TMedicare PIN
FLPA9101346OtherLICENSE