Healthcare Provider Details

I. General information

NPI: 1518446400
Provider Name (Legal Business Name): FXM CLINICAL RESEARCH MIRAMAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2018
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14601 SW 29TH ST STE 208
MIRAMAR FL
33027-4714
US

IV. Provider business mailing address

14601 SW 29TH ST STE 208
MIRAMAR FL
33027-4714
US

V. Phone/Fax

Practice location:
  • Phone: 954-430-1097
  • Fax: 305-675-3152
Mailing address:
  • Phone: 954-430-1097
  • Fax: 305-675-3152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License NumberPA9110219
License Number StateFL

VIII. Authorized Official

Name: MARITZA D. DIEGO
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PA-C
Phone: 954-430-1097