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General NPI Number Information
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NPI Number | 1427386739
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Entity Type | Organization
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Legal Business Name | DFAS
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Dates
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Enumeration Date | 11/24/2009
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Last Update Date | 11/24/2009
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Provider Practice Location Address
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Address Line | 1201 NW 16TH ST
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City | MIAMI
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State | FL
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Zip | 33125-1624
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Country | US
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Telephone | 305-575-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 571 SW 176TH AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-4010
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | LONG TRAN
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Credential |
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Telephone | 757-650-5406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number | 0002074774
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | PN5186921
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License Number State | FL
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