=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396890562
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IFA UNIVERSAL HOME CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2007
-----------------------------------------------------
Last Update Date | 09/11/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9105 TAFT ST
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33024-4652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-961-2170
-----------------------------------------------------
Fax | 954-961-2171
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9105 TAFT ST
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33024-4652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-961-2170
-----------------------------------------------------
Fax | 954-961-2171
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | EDUARDO LIERMO SR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-905-0677
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 170100000X
-----------------------------------------------------
Taxonomy Name | Ph.D. Medical Genetics
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------