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General NPI Number Information
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NPI Number | 1174196695
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Entity Type | Organization
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Legal Business Name | FWC PERINATAL, LLC
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Dates
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Enumeration Date | 07/22/2021
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Last Update Date | 11/09/2021
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Provider Practice Location Address
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Address Line | 2300 S CONGRESS AVE STE 104
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-7400
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Country | US
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Telephone | 561-740-7970
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Fax | 561-740-7980
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Provider Business Mailing Address
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Address Line | PO BOX 9100
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City | BELFAST
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State | ME
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Zip | 04915-9100
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Country | US
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Telephone | 561-300-2410
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Fax | 561-235-7292
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Authorized Official
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Title or Position | MANAGER
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Name | ERICA HERNANDEZ
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Credential |
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Telephone | 561-300-2410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number |
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License Number State |
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