Healthcare Provider Details

I. General information

NPI: 1366874943
Provider Name (Legal Business Name): FRED MAJAVA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5811 NE 21ST DR
FORT LAUDERDALE FL
33308-2511
US

IV. Provider business mailing address

5811 NE 21ST DR
FORT LAUDERDALE FL
33308-2511
US

V. Phone/Fax

Practice location:
  • Phone: 954-562-6334
  • Fax:
Mailing address:
  • Phone: 954-562-6334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT4412
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: