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General NPI Number Information
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NPI Number | 1184931339
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE HEALTH & WELLNESS CENTER, P.A.
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Dates
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Enumeration Date | 09/09/2010
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Last Update Date | 08/25/2022
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Provider Practice Location Address
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Address Line | 4040 SHERIDAN ST
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City | HOLLYWOOD
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State | FL
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Zip | 33021-3536
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Country | US
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Telephone | 954-322-7166
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Fax | 954-322-7169
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Provider Business Mailing Address
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Address Line | 4040 SHERIDAN ST
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City | HOLLYWOOD
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State | FL
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Zip | 33021-3536
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Country | US
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Telephone | 954-322-7166
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Fax | 954-322-7169
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK DERRICK CHIN-LENN
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Credential | M.D.
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Telephone | 954-322-7166
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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 | ME89650
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License Number State | FL
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