Healthcare Provider Details

I. General information

NPI: 1245401538
Provider Name (Legal Business Name): MARLENE CRUZ-GOVIN O D PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4577 WESTON RD
WESTON FL
33331-3141
US

IV. Provider business mailing address

10521 MARIN RANCHES DR
COOPER CITY FL
33328-6301
US

V. Phone/Fax

Practice location:
  • Phone: 954-217-5070
  • Fax: 954-217-5070
Mailing address:
  • Phone: 954-275-1437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC2935
License Number StateFL

VIII. Authorized Official

Name: DR. MARLENE CRUZ-GOVIN
Title or Position: PRESIDENT
Credential:
Phone: 954-275-1437