Basic Information
| Provider Information | |||||||||
| NPI: | 1255409959 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VIA Y RADA | ||||||||
| FirstName: | NESTOR | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 JFK DR STE 320 | ||||||||
| Address2: | |||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334626641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615484900 | ||||||||
| FaxNumber: | 5614345165 | ||||||||
| Practice Location | |||||||||
| Address1: | 180 JFK DR STE 320 | ||||||||
| Address2: | |||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334626641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615484900 | ||||||||
| FaxNumber: | 5614345165 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 05/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | PA9101346 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | PA9101346 | 01 | FL | LICENSE | OTHER |