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General NPI Number Information
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NPI Number | 1467943126
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Entity Type | Organization
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Legal Business Name | BL MEDICAL CENTER, INC
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Dates
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Enumeration Date | 05/29/2018
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Last Update Date | 08/29/2018
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Provider Practice Location Address
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Address Line | 9050 PINES BLVD STE 363
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City | PEMBROKE PINES
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State | FL
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Zip | 33024
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Country | US
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Telephone | 954-639-7738
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Fax | 954-639-7735
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Provider Business Mailing Address
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Address Line | 9050 PINES BLVD STE 363
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6400
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Country | US
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Telephone | 954-639-7738
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Fax | 954-639-7735
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Authorized Official
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Title or Position | CEO
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Name | LUIS G FERNANDEZ
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Credential |
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Telephone | 954-639-7738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology 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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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | HCC11480
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License Number State | FL
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