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General NPI Number Information
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NPI Number | 1144097809
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Entity Type | Individual
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Provider Name | MR. GREGORY BOISROND
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Gender | Male
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Dates
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Enumeration Date | 12/04/2023
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 18450 NW 8TH RD
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City | MIAMI GARDENS
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State | FL
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Zip | 33169-3714
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Country | US
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Telephone | 786-428-7335
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Fax |
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Provider Business Mailing Address
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Address Line | 17945 NW 5TH CT
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City | MIAMI GARDENS
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State | FL
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Zip | 33169-4324
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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