Healthcare Provider Details

I. General information

NPI: 1255729026
Provider Name (Legal Business Name): PLAY SAFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2015
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 WEST HALLANDALE BEACH BLVD
HALLANDALE FL
33009
US

IV. Provider business mailing address

1008 WEST HALLANDALE BEACH BLVD
HALLANDALE FL
33009
US

V. Phone/Fax

Practice location:
  • Phone: 954-456-5680
  • Fax: 954-456-5682
Mailing address:
  • Phone: 954-456-5680
  • Fax: 954-456-5682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberARNPN9192902
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberARNP9192984
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberME47182
License Number StateFL

VIII. Authorized Official

Name: VIVIAN CHONA
Title or Position: ARNP/OWNER
Credential: ARNP
Phone: 954-456-5680