Healthcare Provider Details

I. General information

NPI: 1407934912
Provider Name (Legal Business Name): MOHAMMAD JAWED LATIF JANGDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 N UNIVERSITY DR
PEMBROKE PINES FL
33024-3611
US

IV. Provider business mailing address

8050 N UNIVERSITY DR STE 201
TAMARAC FL
33321-2102
US

V. Phone/Fax

Practice location:
  • Phone: 954-730-3340
  • Fax: 954-730-8879
Mailing address:
  • Phone: 854-532-2920
  • Fax: 866-843-0820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberME78898
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberME78898
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberME78898
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: