Healthcare Provider Details

I. General information

NPI: 1285396838
Provider Name (Legal Business Name): PANACEA BIOMEDICAL INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1761 NE 42ND ST
OAKLAND PARK FL
33334-5463
US

IV. Provider business mailing address

1761 NE 42ND ST
OAKLAND PARK FL
33334-5463
US

V. Phone/Fax

Practice location:
  • Phone: 786-422-1776
  • Fax: 954-417-6105
Mailing address:
  • Phone: 786-422-1776
  • Fax: 954-417-6105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: CLAUDIA MARCELO
Title or Position: OWNER
Credential: DO
Phone: 813-546-3791