Healthcare Provider Details

I. General information

NPI: 1750377453
Provider Name (Legal Business Name): COMPLETE LOCAL SPECIALTY CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E HALLANDALE BEACH BLVD STE 301
HALLANDALE BEACH FL
33009
US

IV. Provider business mailing address

4855 W HILLSBORO BLVD STE B2
COCONUT CREEK FL
33073
US

V. Phone/Fax

Practice location:
  • Phone: 954-458-2572
  • Fax: 954-354-8151
Mailing address:
  • Phone: 954-418-1683
  • Fax: 954-418-1698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHANTAL BRAY
Title or Position: PRESIDENT
Credential:
Phone: 954-418-1683