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General NPI Number Information
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NPI Number | 1154043412
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Entity Type | Organization
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Legal Business Name | JUVENIS MEDICAL LLC
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Dates
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Enumeration Date | 09/14/2022
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 4750 N FEDERAL HWY STE 203
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-4609
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Country | US
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Telephone | 954-494-3711
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Fax | 954-776-9953
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Provider Business Mailing Address
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Address Line | 4750 N FEDERAL HWY STE 203
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-4609
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Country | US
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Telephone | 954-494-3711
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Fax | 954-776-9953
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Authorized Official
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Title or Position | CEO
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Name | PAUL GOODKIN
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Credential |
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Telephone | 954-494-3711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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