=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356909196
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MONIZE MEDICAL GROUP, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2019
-----------------------------------------------------
Last Update Date | 03/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1216 SE 1ST AVE
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33316-1802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-231-4444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8958 W STATE ROAD 84 # 227
-----------------------------------------------------
City | DAVIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33324-4457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-231-4444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BRIAN MONIZE
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 954-231-4444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------