Healthcare Provider Details

I. General information

NPI: 1174743744
Provider Name (Legal Business Name): LAS OLAS URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 08/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2607 NE 10TH AVE
WILTON MANORS FL
33334-3707
US

IV. Provider business mailing address

2607 NE 10TH AVE
WILTON MANORS FL
33334-3707
US

V. Phone/Fax

Practice location:
  • Phone: 954-763-1230
  • Fax:
Mailing address:
  • Phone: 954-763-1230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JEANNETTE GARZON
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 954-763-1230