Healthcare Provider Details

I. General information

NPI: 1447546643
Provider Name (Legal Business Name): IRENE MARIE HOTALEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9050 PINES BLVDS. SUITE 200
PEMBROKE PINES FL
33024-6456
US

IV. Provider business mailing address

9050 PINES BLVDS. SUITE 200
PEMBROKE PINES FL
33024-6456
US

V. Phone/Fax

Practice location:
  • Phone: 954-437-4800
  • Fax: 954-437-6628
Mailing address:
  • Phone: 954-437-4800
  • Fax: 954-437-6628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036141026
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME131817
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: