Healthcare Provider Details

I. General information

NPI: 1396175089
Provider Name (Legal Business Name): BROWARD PRIMARY CARE CLINICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 N STATE ROAD 7 SUITE:2
PLANTATION FL
33317-2117
US

IV. Provider business mailing address

660 N STATE ROAD 7 SUITE:2
PLANTATION FL
33317-2117
US

V. Phone/Fax

Practice location:
  • Phone: 954-288-9338
  • Fax:
Mailing address:
  • Phone: 954-288-9338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME87727
License Number StateFL

VIII. Authorized Official

Name: CLAUDIA PENA
Title or Position: OWNER
Credential:
Phone: 954-288-9338