Healthcare Provider Details

I. General information

NPI: 1487772257
Provider Name (Legal Business Name): CENTER FOR RECONSTRUCTIVE SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N FLAMINGO RD SUITE#408
PEMBROKE PINES FL
33028-1015
US

IV. Provider business mailing address

601 N FLAMINGO RD SUITE#408
PEMBROKE PINES FL
33028-1015
US

V. Phone/Fax

Practice location:
  • Phone: 954-437-2436
  • Fax:
Mailing address:
  • Phone: 954-437-2436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LYNN STREINER
Title or Position: OFFICE MANAGER
Credential:
Phone: 954-437-2436