Healthcare Provider Details

I. General information

NPI: 1659717049
Provider Name (Legal Business Name): LAXMI MEDICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 W CAMINO REAL STE 102
BOCA RATON FL
33433-5514
US

IV. Provider business mailing address

5817 N UNIVERSITY DR
TAMARAC FL
33321
US

V. Phone/Fax

Practice location:
  • Phone: 561-235-5206
  • Fax:
Mailing address:
  • Phone: 561-235-5206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LATA SHINTRE
Title or Position: OWNER
Credential:
Phone: 561-235-5206