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General NPI Number Information
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NPI Number | 1083072995
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Entity Type | Organization
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Legal Business Name | B2G DOCTORS
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Dates
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Enumeration Date | 02/05/2016
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Last Update Date | 02/05/2016
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Provider Practice Location Address
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Address Line | 1495 N PARK DR
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City | WESTON
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State | FL
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Zip | 33326-3215
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Country | US
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Telephone | 954-319-2259
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Fax |
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Provider Business Mailing Address
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Address Line | 1495 N PARK DR
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City | WESTON
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State | FL
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Zip | 33326-3215
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Country | US
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Telephone | 954-319-2259
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. THANIA QUESADA
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Credential | MD
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Telephone | 954-536-9549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 0647369300701
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License Number State | FL
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