Healthcare Provider Details

I. General information

NPI: 1053688317
Provider Name (Legal Business Name): PBCGME/PALMS WEST HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 SOUTHERN BLVD
LOXAHATCHEE FL
33470-9203
US

IV. Provider business mailing address

13001 SOUTHERN BLVD
LOXAHATCHEE FL
33470-9203
US

V. Phone/Fax

Practice location:
  • Phone: 561-784-3127
  • Fax:
Mailing address:
  • Phone: 561-784-3127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number
License Number State

VIII. Authorized Official

Name: MARLENE CARABALLO
Title or Position: DIRECTOR OF MEDICAL EDUCATION
Credential: DO
Phone: 561-784-3127