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General NPI Number Information
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NPI Number | 1295053460
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL MEDICAL ASSOCIATES LLC
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Dates
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Enumeration Date | 05/12/2010
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Last Update Date | 05/12/2010
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Provider Practice Location Address
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Address Line | 2301 N UNIVERSITY DR SUITE# 205
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-3617
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Country | US
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Telephone | 954-962-4680
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Fax | 954-966-6927
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Provider Business Mailing Address
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Address Line | 2301 N UNIVERSITY DR SUITE# 205
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-3617
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Country | US
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Telephone | 954-962-4680
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Fax | 954-966-6927
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ZENOBIA MIRO-BERKELEY
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Credential | M.D.
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Telephone | 954-962-4680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | ME98247
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME81885
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License Number State | FL
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