Healthcare Provider Details

I. General information

NPI: 1962090993
Provider Name (Legal Business Name): WZRD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 04/02/2023
Certification Date: 04/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 HOLLYWOOD BLVD
HOLLYWOOD FL
33019-1608
US

IV. Provider business mailing address

6813 FINAMORE CIR
LAKE WORTH FL
33467-8727
US

V. Phone/Fax

Practice location:
  • Phone: 954-483-3381
  • Fax: 954-516-0720
Mailing address:
  • Phone: 954-483-3381
  • Fax: 954-516-0720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KHALED DEEB
Title or Position: OWNER, AUTHORIZED OFFICIAL
Credential: MD, PHD, MBA
Phone: 954-483-3811