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General NPI Number Information
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NPI Number | 1053580027
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Entity Type | Organization
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Legal Business Name | SOUTHWEST BROWARD
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 02/25/2008
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Provider Practice Location Address
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Address Line | 18503 PINES BLVD SUITE 305
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-1404
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Country | US
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Telephone | 954-392-1851
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Fax |
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Provider Business Mailing Address
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Address Line | 18503 PINES BLVD SUITE 305
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-1404
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Country | US
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Telephone | 954-392-1851
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALVARO BETANCUR
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Credential |
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Telephone | 954-392-1851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number | 12267
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | 12267
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | 12267
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 12267
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License Number State | FL
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