Blaiq Services

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Legal business name

BLAIQ SERVICES

Practice address

4711 S Indian River Dr
Fort Pierce, FL 34982-7769

Phone

(916) 952-5532

NPI assigned

Apr 18, 2024

Last updated

Apr 20, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Justin DuharteNPI 1437904091

Title

Surgical Assistant Certified

Phone

(916) 952-5532

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Justin Duharte, SAC

  • Surgical Physician Assistant
  • Fort Pierce, FL
  • NPI 1437904091
  NPD Authorized official

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

{
    "created_epoch": "1713398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713571200000",
    "number": "1982459434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4711 S INDIAN RIVER DR",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349827769",
            "telephone_number": "916-952-5532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4711 S INDIAN RIVER DR",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349827769",
            "telephone_number": "916-952-5532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLAIQ SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-18",
        "last_updated": "2024-04-20",
        "certification_date": "2024-04-20",
        "status": "A",
        "authorized_official_last_name": "DUHARTE",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "SURGICAL ASSISTANT CERTIFIED",
        "authorized_official_telephone_number": "916-952-5532"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandon Le'Charles Bishop, DO
• Sandra Bivens
• Raquel Bizzell
• Phyllis Black
• Tessa Maloney Black, RN
• Susan Marie Blair Khayyat, MA
• Sharonda Blake
• Ericia Blanton
• Riley Blay
• Blessed-in-Care LLC

• Surgical Physician Assistant in Fort Pierce, FL
• Providers in Fort Pierce, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2024; 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.