Healthcare Provider Details

I. General information

NPI: 1689946824
Provider Name (Legal Business Name): US MEDICAL CARE WELLINGTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11903 SOUTHERN BLVD SUIT 108
ROYAL PALM BEACH FL
33411-7644
US

IV. Provider business mailing address

11903 SOUTHERN BLVD SUIT 108
ROYAL PALM BEACH FL
33411-7644
US

V. Phone/Fax

Practice location:
  • Phone: 561-792-2000
  • Fax: 561-792-2090
Mailing address:
  • Phone: 561-792-2000
  • Fax: 561-792-2090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VB0002X
TaxonomyObesity Medicine (Obstetrics & Gynecology) Physician
License NumberME26716
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME83741
License Number StateFL

VIII. Authorized Official

Name: DR. SASSON MOULAVI
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 561-445-4489