Healthcare Provider Details

I. General information

NPI: 1477017986
Provider Name (Legal Business Name): BERLINE LOUIS-FERTIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3911 HOLLYWOOD BLVD
HOLLYWOOD FL
33021-6795
US

IV. Provider business mailing address

3911 HOLLYWOOD BLVD
HOLLYWOOD FL
33021-6795
US

V. Phone/Fax

Practice location:
  • Phone: 954-639-7345
  • Fax:
Mailing address:
  • Phone: 954-639-7345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: