Healthcare Provider Details

I. General information

NPI: 1093622128
Provider Name (Legal Business Name): DEMETRA CHRISTINA PAHOPOS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 N 35TH AVE
HOLLYWOOD FL
33021-5402
US

IV. Provider business mailing address

1525 W CYPRESS CREEK RD
FORT LAUDERDALE FL
33309
US

V. Phone/Fax

Practice location:
  • Phone: 954-939-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: