=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093372260
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FED HELP MEDICAL OF WEST BROWARD, CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2019
-----------------------------------------------------
Last Update Date | 07/01/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2121 W OAKLAND PARK BLVD STE 8
-----------------------------------------------------
City | OAKLAND PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33311-1507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 754-216-0796
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2121 W OAKLAND PARK BLVD STE 8
-----------------------------------------------------
City | OAKLAND PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33311-1507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 754-216-0796
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DANAY QUEVEDO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 754-216-0796
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------