Healthcare Provider Details

I. General information

NPI: 1427407493
Provider Name (Legal Business Name): FOCUS CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 06/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12712 N WINNERS CIR
DAVIE FL
33330-4322
US

IV. Provider business mailing address

12712 N WINNERS CIR
DAVIE FL
33330-4322
US

V. Phone/Fax

Practice location:
  • Phone: 305-776-0060
  • Fax:
Mailing address:
  • Phone: 305-776-0060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME87905
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA14531
License Number StateFL

VIII. Authorized Official

Name: DR. NATHANIEL KELLER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 305-776-0060