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General NPI Number Information
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NPI Number | 1376011551
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Entity Type | Organization
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Legal Business Name | PERSONALIZED MEDICINE INSTITUTE, LLC.
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Dates
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Enumeration Date | 11/06/2018
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 4765 SW 148TH AVE STE 404
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City | DAVIE
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State | FL
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Zip | 33330-2128
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Country | US
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Telephone | 203-300-0147
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Fax | 954-634-4293
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Provider Business Mailing Address
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Address Line | 4765 VOLUNTEER RD STE 404
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City | DAVIE
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State | FL
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Zip | 33330-2128
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Country | US
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Telephone | 954-374-7545
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Fax | 954-374-7543
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Authorized Official
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Title or Position | CEO
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Name | MAXIMO JOSE FERNANDEZ
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Credential | MD
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Telephone | 954-552-7209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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Taxonomy #3
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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