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General NPI Number Information
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NPI Number | 1134708340
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Entity Type | Organization
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Legal Business Name | JUANA BORDELEAU
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Dates
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Enumeration Date | 04/05/2021
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Last Update Date | 04/05/2021
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Provider Practice Location Address
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Address Line | 3472 FOREST HILL BLVD STE 2C
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City | PALM SPRINGS
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State | FL
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Zip | 33406-5864
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Country | US
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Telephone | 561-229-6189
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Fax |
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Provider Business Mailing Address
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Address Line | 4537 SANDY COVE TER
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City | LAKE WORTH
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State | FL
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Zip | 33467-1112
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JUANA BORDELEAU
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Credential | APRN
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Telephone | 561-229-6189
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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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