Healthcare Provider Details

I. General information

NPI: 1902424898
Provider Name (Legal Business Name): DONNA MARIE MINORS RCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 N OCEAN BLVD
POMPANO BEACH FL
33062-3422
US

IV. Provider business mailing address

PO BOX 24954
FT LAUDERDALE FL
33307-4954
US

V. Phone/Fax

Practice location:
  • Phone: 954-899-1108
  • Fax:
Mailing address:
  • Phone: 954-899-1108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberTT13690
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: