ISMARY CHACON, PA-C
Medical Practice at 167 St, Miami, FL

License number
Florida PA9107555
Category
Nursing
Type
Medical
Address
Address 2
301 NE 167Th St, Miami, FL 33162
1558 NW 159Th Ave, Hollywood, FL 33028
Phone
(305) 940-0522
(305) 653-1138 (Fax)
National Provider ID: 1942626155
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

See more information about ISMARY CHACON at bizstanding.com

ISMARY CHACON PA

1558 NW 159 Ave, Hollywood, FL 33028

Status:
Inactive
Inactive reason:
ADMIN DISSOLUTION FOR ANNUAL REPORT
Registration:
Oct 27, 2004
Inactive since:
Sep 26, 2008
State ID:
P04000147928
Business type:
Florida Profit Corporation
President:
Ismary Chacon President, inactive, 1558 NW 159 Ave, Hollywood, FL 33028 (Physical)
Agent:
Chacon, Ismary,1558 NW 159 Ave, Hollywood, FL 33028 (Physical)
EIN:
20-1808095

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