Healthcare Provider Details

I. General information

NPI: 1902235856
Provider Name (Legal Business Name): KARLA RIQUER POLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2013
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 S PERIMETER RD STE 120
FT LAUDERDALE FL
33309-7123
US

IV. Provider business mailing address

1925 S PERIMETER RD STE 120
FT LAUDERDALE FL
33309-7123
US

V. Phone/Fax

Practice location:
  • Phone: 954-958-0988
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: