Healthcare Provider Details

I. General information

NPI: 1144658626
Provider Name (Legal Business Name): CIRCULATORY CARE & DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2013
Last Update Date: 10/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 S FLAMINGO RD #102
PEMBROKE PINES FL
33027-1770
US

IV. Provider business mailing address

320 S FLAMINGO RD #102
PEMBROKE PINES FL
33027-1770
US

V. Phone/Fax

Practice location:
  • Phone: 850-212-6636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: BERNARD ASHBY
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 850-212-6636