Healthcare Provider Details

I. General information

NPI: 1336588276
Provider Name (Legal Business Name): LAKEVIEW MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 RED RD STE 601A
MIRAMAR FL
33025-6016
US

IV. Provider business mailing address

3600 RED RD STE 601A
MIRAMAR FL
33025-6016
US

V. Phone/Fax

Practice location:
  • Phone: 954-391-8529
  • Fax: 954-342-9479
Mailing address:
  • Phone: 954-391-8529
  • Fax: 954-342-9479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberHCC10683
License Number StateFL

VIII. Authorized Official

Name: MS. DIULYS MARTINEZ
Title or Position: OWNER/ PRESIDENT
Credential:
Phone: 954-391-8529