Healthcare Provider Details

I. General information

NPI: 1942051297
Provider Name (Legal Business Name): FAMILY MEDICAL GROUP PEMBROKE PINES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9050 PINES BLVD STE 335
PEMBROKE PINES FL
33024-6442
US

IV. Provider business mailing address

9050 PINES BLVD STE 335
PEMBROKE PINES FL
33024-6442
US

V. Phone/Fax

Practice location:
  • Phone: 954-256-5552
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: LIZSANDRA RODRIGUEZ
Title or Position: OWNER
Credential:
Phone: 786-399-7390