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General NPI Number Information
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NPI Number | 1114223831
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Entity Type | Organization
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Legal Business Name | PINES CARE MEDICAL CENTER, LLC
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Dates
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Enumeration Date | 01/27/2011
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Last Update Date | 10/30/2014
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Provider Practice Location Address
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Address Line | 501 NW 103 AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33026
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Country | US
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Telephone | 954-251-1497
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Fax | 954-404-9537
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Provider Business Mailing Address
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Address Line | 501 NW 103 AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33026
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Country | US
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Telephone | 954-251-1497
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Fax | 954-404-9537
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. YANELYS TREJO
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Credential |
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Telephone | 954-251-1497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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