Healthcare Provider Details

I. General information

NPI: 1164035861
Provider Name (Legal Business Name): FAMILIA HEALTH CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 W HILLSBORO BLVD
DEERFIELD BEACH FL
33441-1604
US

IV. Provider business mailing address

450 W HILLSBORO BLVD
DEERFIELD BEACH FL
33441-1604
US

V. Phone/Fax

Practice location:
  • Phone: 954-531-0461
  • Fax: 954-531-0713
Mailing address:
  • Phone: 954-531-0461
  • Fax: 954-531-0713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ARTHUR SODERBERG
Title or Position: CFO
Credential:
Phone: 954-531-0461