Healthcare Provider Details

I. General information

NPI: 1639114580
Provider Name (Legal Business Name): LAURENTINA P KOCIK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S DOUGLAS RD
PEMBROKE PINES FL
33025-1355
US

IV. Provider business mailing address

14050 NW 14TH ST SUITE 190
SUNRISE FL
33323-2865
US

V. Phone/Fax

Practice location:
  • Phone: 954-985-1470
  • Fax:
Mailing address:
  • Phone: 800-424-3672
  • Fax: 954-377-3042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME28084
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME28084
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: