Florida Plastic Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

1936 Issued in FL

Legal business name

FLORIDA PLASTIC SURGERY CENTER, LLC

Practice address

1220 59TH St W
Bradenton, FL 34209-4154

Phone

(941) 795-2088

Fax

(941) 792-5139

NPI assigned

May 14, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Enrique J Fernandezm, M.D.

Title

Owner

Phone

(941) 795-2088

Specialties & licenses 1

Addresses

Other names 1

• Bradenton Plastic Surgery Center, LLC Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349395200000",
    "number": "1750596359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 59TH ST W",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342094154",
            "telephone_number": "941-795-2088",
            "fax_number": "941-792-5139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 59TH ST W",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342094154",
            "telephone_number": "941-795-2088",
            "fax_number": "941-792-5139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA PLASTIC SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-14",
        "last_updated": "2012-10-05",
        "status": "A",
        "authorized_official_last_name": "FERNANDEZM",
        "authorized_official_first_name": "ENRIQUE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "941-795-2088",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "FL",
            "license": "1936",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bradenton Plastic Surgery Center, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Ambulatory Surgical Clinic/Center in Bradenton, FL
• Providers in Bradenton, FL by specialty
• Ambulatory Surgical Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.