Healthcare Provider Details

I. General information

NPI: 1598710469
Provider Name (Legal Business Name): MILLENNIUM MEDICAL & TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2742 SW 8TH ST
MIAMI FL
33135-4636
US

IV. Provider business mailing address

121 S STATE ROAD 7
PLANTATION FL
33317-3733
US

V. Phone/Fax

Practice location:
  • Phone: 305-924-5474
  • Fax:
Mailing address:
  • Phone: 305-924-5474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. JOSE A BROCHE
Title or Position: PRESIDENT
Credential:
Phone: 305-924-5474