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General NPI Number Information
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NPI Number | 1427407493
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Entity Type | Organization
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Legal Business Name | FOCUS CLINIC, INC.
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Dates
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Enumeration Date | 06/09/2016
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Last Update Date | 06/09/2016
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Provider Practice Location Address
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Address Line | 12712 N WINNERS CIR
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City | DAVIE
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State | FL
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Zip | 33330-4322
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Country | US
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Telephone | 305-776-0060
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Fax |
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Provider Business Mailing Address
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Address Line | 12712 N WINNERS CIR
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City | DAVIE
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State | FL
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Zip | 33330-4322
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Country | US
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Telephone | 305-776-0060
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NATHANIEL KELLER
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Credential | M.D.
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Telephone | 305-776-0060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA14531
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME87905
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License Number State | FL
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