Healthcare Provider Details

I. General information

NPI: 1891728119
Provider Name (Legal Business Name): PREVENTIVE HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N FEDERAL HWY SUITE #102
HALLANDALE BEACH FL
33009-2400
US

IV. Provider business mailing address

1001 N FEDERAL HWY SUITE #102
HALLANDALE BEACH FL
33009-2400
US

V. Phone/Fax

Practice location:
  • Phone: 954-458-2559
  • Fax: 954-457-1861
Mailing address:
  • Phone: 954-458-2559
  • Fax: 954-457-1861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME85417
License Number StateFL

VIII. Authorized Official

Name: DR. LISSA M JEAN-PIERRE
Title or Position: GENERAL PRACTICE
Credential: MD
Phone: 954-458-2559