MEDICARE: BROWARD QUALITY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	114506	OTHER	FL	HUMANA

General Provider Information

NPI Number	:	1407841091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROWARD QUALITY LLC

Provider Business Mailing Address
First Line	:	6301 PEMBROKE RD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33023-2217
Country	:	US
Telephone Number	:	954-961-8394
Fax Number	:	954-241-0445

Provider Business Practice Location Address
First Line	:	6301 PEMBROKE RD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33023-2217
Country	:	US
Telephone Number	:	954-961-8394
Fax Number	:	954-241-0445

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. ROSA M ROCA
Credential	:
Telephone Number	:	954-961-8394

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	08/22/2020

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Directions to “BROWARD QUALITY LLC ” Practice Location

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