Healthcare Provider Details

I. General information

NPI: 1245429463
Provider Name (Legal Business Name): BROWARD INSTITUTE OF NEURO SCIENCE L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 WILES RD STE 105
CORAL SPRINGS FL
33067-2063
US

IV. Provider business mailing address

7501 WILES RD STE 105
CORAL SPRINGS FL
33067-2063
US

V. Phone/Fax

Practice location:
  • Phone: 954-341-1022
  • Fax: 954-341-1082
Mailing address:
  • Phone: 954-341-1022
  • Fax: 954-341-1082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberBE8849854
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: RICARDO K ESPAILLAT
Title or Position: CLINICAL DIRECTOR/CHAIRMAN
Credential: MD
Phone: 954-341-1022