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General NPI Number Information
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NPI Number | 1063910800
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Entity Type | Organization
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Legal Business Name | JOSETTE BOUKHALIL-LAKLAK MD PA
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Dates
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Enumeration Date | 01/26/2018
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Last Update Date | 03/20/2018
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Provider Practice Location Address
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Address Line | 18430 S DIXIE HWY
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City | CUTLER BAY
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State | FL
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Zip | 33157-6816
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Country | US
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Telephone | 305-253-0123
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Fax | 305-253-0177
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Provider Business Mailing Address
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Address Line | 18430 S DIXIE HWY
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City | CUTLER BAY
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State | FL
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Zip | 33157-6816
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Country | US
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Telephone | 305-253-0123
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Fax | 305-253-0177
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JOSETTE BOUKHALIL-LAKLAK
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Credential |
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Telephone | 305-253-0040
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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 | ME0097334
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License Number State | FL
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