Healthcare Provider Details

I. General information

NPI: 1962908947
Provider Name (Legal Business Name): HANS HEUBEL PEER SPECIALIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 N. 29TH AVENUE
HOLLYWOOD FL
33020
US

IV. Provider business mailing address

3400 N. 29TH AVENUE
HOLLYWOOD FL
33020
US

V. Phone/Fax

Practice location:
  • Phone: 954-276-3408
  • Fax: 954-965-6444
Mailing address:
  • Phone: 954-276-3408
  • Fax: 954-965-6444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: