Healthcare Provider Details

I. General information

NPI: 1407228315
Provider Name (Legal Business Name): AFFORDAHEALTH OF POMPANO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 10/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 NE 26TH AVE SUITE 203
POMPANO BEACH FL
33062-5239
US

IV. Provider business mailing address

50 NE 26TH AVE SUITE 203
POMPANO BEACH FL
33062-5239
US

V. Phone/Fax

Practice location:
  • Phone: 954-781-6908
  • Fax: 954-781-6909
Mailing address:
  • Phone: 954-781-6908
  • Fax: 954-781-6909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA B BURKE
Title or Position: MGMR
Credential:
Phone: 954-781-6908