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General NPI Number Information
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NPI Number | 1023472024
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Entity Type | Organization
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Legal Business Name | SOUTH BROWARD MEDICAL MANAGEMENT, INC.
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Dates
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Enumeration Date | 04/06/2016
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Last Update Date | 04/06/2016
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Provider Practice Location Address
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Address Line | 17890 NW 2ND ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-2806
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Country | US
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Telephone | 954-442-6090
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Fax |
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Provider Business Mailing Address
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Address Line | 7400 PEPPERTREE CIR N
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City | DAVIE
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State | FL
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Zip | 33314-6914
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Country | US
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Telephone | 954-442-6090
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. DAYAMI MARTIN LUGO
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Credential |
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Telephone | 954-442-6090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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