=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538478722
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FALONA KING PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2010
-----------------------------------------------------
Last Update Date | 08/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 E BOYNTON BEACH BLVD
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33435-3839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-732-3200
-----------------------------------------------------
Fax | 561-732-6849
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 211 E BOYNTON BEACH BLVD
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33435-3839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-732-3200
-----------------------------------------------------
Fax | 561-732-6849
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA9101568
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------