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General NPI Number Information
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NPI Number | 1528557394
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Entity Type | Organization
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Legal Business Name | ALLIED HEALTH PROVIDER LLC
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Dates
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Enumeration Date | 05/07/2018
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Last Update Date | 05/07/2018
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Provider Practice Location Address
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Address Line | 1625 NE 3RD CT
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-3808
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Country | US
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Telephone | 305-989-7291
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Fax |
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Provider Business Mailing Address
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Address Line | 701 THREE ISLANDS BLVD STE 118
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-2822
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Country | US
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Telephone | 305-989-7291
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Fax |
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Authorized Official
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Title or Position | OWNER / PROVIDER
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Name | DIANA MARTINEZ
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Credential | PA-C
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Telephone | 305-989-7291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9105777
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License Number State | FL
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