Fanie Augustama

NPI #1245763317 in Sunrise, Florida

Provider Information

NPI Number: 1245763317
Entity Type: Individual
Name: Fanie Augustama
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Technician, Other
Enumeration Date: Apr 6, 2017
Last Updated: Apr 6, 2017

Practice Location

Address: 8632 NW 34TH PL APT C102
City: Sunrise
State: Florida
ZIP Code: 33351-6652
Phone: (954) 245-2401

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Technician, Other	247200000X	Primary

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