Healthcare Provider Details

I. General information

NPI: 1265810477
Provider Name (Legal Business Name): CITRIN MEDICAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2061 NW BOCA RATON BLVD STE 106
BOCA RATON FL
33431
US

IV. Provider business mailing address

2061 NW BOCA RATON BLVD STE106
BOCA RATON FL
33431
US

V. Phone/Fax

Practice location:
  • Phone: 561-303-2912
  • Fax: 561-303-2951
Mailing address:
  • Phone: 561-303-2912
  • Fax: 561-303-2951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS12975
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. MAX CITRIN
Title or Position: OWNER
Credential: DO
Phone: 561-303-2912