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General NPI Number Information
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NPI Number | 1508269572
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Entity Type | Organization
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Legal Business Name | ORTHONOW WESTON
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Dates
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Enumeration Date | 10/03/2014
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Last Update Date | 10/03/2014
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Provider Practice Location Address
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Address Line | 4825 SW 148TH AVE
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City | SOUTHWEST RANCHES
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State | FL
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Zip | 33330-2129
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Country | US
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Telephone | 954-802-6763
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Fax |
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Provider Business Mailing Address
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Address Line | 4825 SW 148TH AVE
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City | SOUTHWEST RANCHES
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State | FL
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Zip | 33330-2129
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Country | US
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Telephone | 954-802-6763
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ASHLEY BOLANOS
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Credential |
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Telephone | 954-802-6763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PS0010X
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Taxonomy Name | Sports Medicine (Emergency Medicine) Physician
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License Number | HCC10353
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License Number State | FL
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