=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336383009
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DBPINES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2009
-----------------------------------------------------
Last Update Date | 04/26/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10810 NW 20TH ST
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33026-2224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-381-0849
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10810 NW 20TH ST
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33026-2224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES.
-----------------------------------------------------
Name | DAVID BRETTLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-381-0849
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 231092
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------