Healthcare Provider Details

I. General information

NPI: 1700264744
Provider Name (Legal Business Name): ASSOCIATES IN FAMILY PRACTICE OF BROWARD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 NW 84TH AVE SUITE 200B
PLANTATION FL
33324
US

IV. Provider business mailing address

4780 SW 64TH AVE STE 103
DAVIE FL
33314-4400
US

V. Phone/Fax

Practice location:
  • Phone: 954-577-2294
  • Fax: 954-577-2297
Mailing address:
  • Phone: 954-279-2572
  • Fax: 954-434-1882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberHCC9620
License Number StateFL

VIII. Authorized Official

Name: MR. LUIS FELIPE LAFRATTA
Title or Position: CEO
Credential:
Phone: 954-434-1705