=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023334745
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA MAGDALENA BELEAN PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2010
-----------------------------------------------------
Last Update Date | 05/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4030 SHERIDAN ST STE C
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33021-3564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-961-7500
-----------------------------------------------------
Fax | 954-964-8965
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1150 N 35TH AVE SUITE 200
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33021-5424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-961-7500
-----------------------------------------------------
Fax | 954-964-8965
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA9105352
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------