Provider Demographics
NPI:1831468669
Name:INTERACTIVE MEDICAL - UNLIMITED SURGICAL ASSISTANT
Entity type:Organization
Organization Name:INTERACTIVE MEDICAL - UNLIMITED SURGICAL ASSISTANT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:ORTIZ DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:954-990-3515
Mailing Address - Street 1:49 N FEDERAL HWY # 361
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-4304
Mailing Address - Country:US
Mailing Address - Phone:954-990-3515
Mailing Address - Fax:
Practice Address - Street 1:49 N FEDERAL HWY # 361
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-4304
Practice Address - Country:US
Practice Address - Phone:954-990-3515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101223363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty