Healthcare Provider Details

I. General information

NPI: 1972871937
Provider Name (Legal Business Name): CAREVANTAGE MEDICAL CENTERS OF BROWARD AT STIRLING ROAD,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2536 N STATE ROAD 7
HOLLYWOOD FL
33021-3205
US

IV. Provider business mailing address

2536 N STATE ROAD 7
HOLLYWOOD FL
33021-3205
US

V. Phone/Fax

Practice location:
  • Phone: 954-983-8844
  • Fax: 954-983-8855
Mailing address:
  • Phone: 954-983-8844
  • Fax: 954-983-8855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ALBERTO LAMADRID
Title or Position: OWNER
Credential:
Phone: 786-691-1110