Healthcare Provider Details

I. General information

NPI: 1316260987
Provider Name (Legal Business Name): URAIRONG RATTANAKORN ARNP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7031 SW 62ND AVE
SOUTH MIAMI FL
33143-4701
US

IV. Provider business mailing address

14001 NW 4TH ST SUITE 202
PEMBROKE PINES FL
33028-2297
US

V. Phone/Fax

Practice location:
  • Phone: 305-284-7500
  • Fax:
Mailing address:
  • Phone: 786-556-1422
  • Fax: 954-391-9687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: URAIRONG RATTANAKORN
Title or Position: OWNER
Credential: ARNP
Phone: 786-556-1422