MEDICARE: EVERTRUST MEDICAL GROUP

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	291U00000X	Clinical Medical Laboratory
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1790649085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERTRUST MEDICAL GROUP

Provider Business Mailing Address
First Line	:	1650 S DIXIE HWY STE 301
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33432-7405
Country	:	US
Telephone Number	:	305-359-7673
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 S DIXIE HWY STE 301
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33432-7405
Country	:	US
Telephone Number	:	305-359-7673
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JACQUELINE LAGUERRE DURAZIL
Credential	:
Telephone Number	:	407-561-4711

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	02/03/2026

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Directions to “EVERTRUST MEDICAL GROUP ” Practice Location

Language	Start Address	Practice Location

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