Healthcare Provider Details

I. General information

NPI: 1982149530
Provider Name (Legal Business Name): LAVERNE RICHARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2017
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SW 9TH ST AP B
HALLANDALE BEACH FL
33009-7026
US

IV. Provider business mailing address

100 SW 9TH ST AP B
HALLANDALE BEACH FL
33009-7026
US

V. Phone/Fax

Practice location:
  • Phone: 340-201-9561
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: