Healthcare Provider Details

I. General information

NPI: 1871500561
Provider Name (Legal Business Name): MS. GLORIA E RITCH I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 N 28TH AVE
HOLLYWOOD FL
33020
US

IV. Provider business mailing address

2202 N 28TH AVE
HOLLYWOOD FL
33020-1810
US

V. Phone/Fax

Practice location:
  • Phone: 954-921-5181
  • Fax:
Mailing address:
  • Phone: 954-921-5181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: