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General NPI Number Information
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NPI Number | 1154644482
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Entity Type | Organization
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Legal Business Name | BROWARD COUNTY RYAN WHITE PART A OFFICE
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Dates
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Enumeration Date | 03/01/2010
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Last Update Date | 03/01/2010
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Provider Practice Location Address
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Address Line | 115 S ANDREWS AVE A-300
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-1818
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Country | US
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Telephone | 954-357-5390
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Fax | 954-357-5897
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Provider Business Mailing Address
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Address Line | 115 S ANDREWS AVE A-300
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-1818
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Country | US
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Telephone | 954-357-5390
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Fax | 954-357-5897
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Authorized Official
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Title or Position | DIVISION DIRECTOR
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Name | MRS. MANDY WELLS
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Credential |
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Telephone | 954-357-8647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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