Healthcare Provider Details

I. General information

NPI: 1134732712
Provider Name (Legal Business Name): PALM BEACH BOUTIQUE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 PROFESSIONAL WAY
WELLINGTON FL
33414-6392
US

IV. Provider business mailing address

227 PROFESSIONAL WAY
WELLINGTON FL
33414-6392
US

V. Phone/Fax

Practice location:
  • Phone: 561-318-8440
  • Fax:
Mailing address:
  • Phone: 561-318-8440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BINA RASHID
Title or Position: OWNER
Credential: MD
Phone: 561-311-8844