Healthcare Provider Details

I. General information

NPI: 1053696864
Provider Name (Legal Business Name): WEST PINES HEALTH CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20170 PINES BLVD. #101
PEMBROKE PINES FL
33029
US

IV. Provider business mailing address

7797 N. UNIVERSITY DR. #101
TAMARAC FL
33321
US

V. Phone/Fax

Practice location:
  • Phone: 965-655-7246
  • Fax:
Mailing address:
  • Phone: 954-655-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH 8420
License Number StateFL

VIII. Authorized Official

Name: DR. DIEGO KOSTZER
Title or Position: OWNER
Credential: DC
Phone: 954-655-7246