Experiontech, LLC
Physician Assistant, Surgical in Clermont, FL. Organization (NPI-2).
NPI number1114403276
StatusActive
Last updated in NPPESDec 16, 2023
Details
- NPI
- 1114403276
- Entity type
- Organization (NPI-2)
- Legal business name
- Experiontech, LLC
- Organization subpart
- No
- Enumeration date
- Jul 12, 2018
- Certification date
- Dec 16, 2023
- Last updated
- Dec 16, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AS0400X | Physician Assistant, Surgical | 18324 | FL | Yes |
Practice location
16756 Abbey Hill CtClermont, FL 34711-6353
Phone 407-480-0295
Mailing address
16756 Abbey Hill CtClermont, FL 34711-6353
Phone 407-480-0295
Authorized official
Paul Lopez
Provider
4074800295
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