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General NPI Number Information
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NPI Number | 1396258083
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Entity Type | Organization
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Legal Business Name | LINE MEDICAL CENTER INC
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Dates
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Enumeration Date | 11/16/2017
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Last Update Date | 11/16/2017
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Provider Practice Location Address
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Address Line | 9050 PINES BLVD STE 190
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6445
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Country | US
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Telephone | 954-744-4608
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Fax | 954-744-4684
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Provider Business Mailing Address
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Address Line | 9050 PINES BLVD STE 190
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6445
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Country | US
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Telephone | 954-744-4608
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Fax | 954-744-4684
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Authorized Official
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Title or Position | PRESIDENT
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Name | BARBARA C FERNANDEZ
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Credential |
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Telephone | 954-744-4608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family 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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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