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General NPI Number Information
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NPI Number | 1235547753
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Entity Type | Individual
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Provider Name | LIDIA BOJORGE
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Gender | Female
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Dates
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Enumeration Date | 07/28/2014
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Last Update Date | 03/22/2017
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Provider Practice Location Address
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Address Line | 1601 S ANDREWS AVE FL 2
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City | FT LAUDERDALE
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State | FL
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Zip | 33316-2509
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Country | US
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Telephone | 954-764-2192
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Fax |
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Provider Business Mailing Address
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Address Line | 2307 W BROWARD BLVD STE 200
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City | FORT LAUDERDALE
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State | FL
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Zip | 33312-1417
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Country | US
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Telephone | 954-792-1010
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Fax | 954-792-1199
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL3608
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License Number State | FL
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