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General NPI Number Information
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NPI Number | 1205139185
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Entity Type | Organization
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Legal Business Name | DIABETES1ON1
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Dates
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Enumeration Date | 12/14/2010
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Last Update Date | 01/03/2011
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Provider Practice Location Address
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Address Line | 1548 SW 189TH TER
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-6143
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Country | US
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Telephone | 305-733-2929
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Fax | 954-367-6789
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Provider Business Mailing Address
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Address Line | 1548 SW 189TH TER
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-6143
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Country | US
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Telephone | 305-733-2929
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Fax | 954-367-6789
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Authorized Official
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Title or Position | CEO
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Name | MR. RAMON LAZARO ARCE JR.
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Credential | RN, CDE, CPT
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Telephone | 305-733-2929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number | 2011-0004
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | RN3367672
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License Number State | FL
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