Healthcare Provider Details

I. General information

NPI: 1265192538
Provider Name (Legal Business Name): CHEN NEIGHBORHOOD MEDICAL CENTERS OF SOUTH FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2021
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 COCONUT CREEK PKWY
MARGATE FL
33063-3913
US

IV. Provider business mailing address

1395 NW 167TH ST
MIAMI GARDENS FL
33169-5710
US

V. Phone/Fax

Practice location:
  • Phone: 954-281-7700
  • Fax: 954-715-7603
Mailing address:
  • Phone: 305-628-6117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MARY CHEN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 305-628-6117