Provider Demographics
NPI:1750532628
Name:DE ZAGO MEDICAL SERVICES, INC.
Entity type:Organization
Organization Name:DE ZAGO MEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA MARIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DE ZAGO
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:954-609-0753
Mailing Address - Street 1:3697 ASPERWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-2259
Mailing Address - Country:US
Mailing Address - Phone:954-609-0753
Mailing Address - Fax:954-427-7526
Practice Address - Street 1:9980 CENTRAL PARK BLVD N
Practice Address - Street 2:SUITE 118
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1762
Practice Address - Country:US
Practice Address - Phone:561-487-0550
Practice Address - Fax:561-883-2639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9174274261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care