=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235216243
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PND MEDICAL SERVICES CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10491 N KENDALL DR SUITE F 210
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33176-1533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-597-6837
-----------------------------------------------------
Fax | 305-598-0019
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10491 N KENDALL DR SUITE F 210
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33176-1533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-597-6837
-----------------------------------------------------
Fax | 305-598-0019
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PATRICIA N DIUANA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-597-6837
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Clinic/Center
-----------------------------------------------------
License Number | AHCA HCC6959
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------