Healthcare Provider Details

I. General information

NPI: 1841653805
Provider Name (Legal Business Name): SIGNATURE PHYSICIANS GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 OSCEOLA DR STE 200AB
WEST PALM BEACH FL
33409-5000
US

IV. Provider business mailing address

900 OSCEOLA DR STE 200AB
WEST PALM BEACH FL
33409-5000
US

V. Phone/Fax

Practice location:
  • Phone: 561-500-7446
  • Fax:
Mailing address:
  • Phone: 561-500-7446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: VERONICA HERNANDEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 954-203-3584