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General NPI Number Information
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NPI Number | 1619313699
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Entity Type | Organization
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Legal Business Name | FLORIDA MEDICAL HEALTH AND WELLNESS CENTER, INC.
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Dates
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Enumeration Date | 05/16/2013
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Last Update Date | 01/30/2014
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Provider Practice Location Address
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Address Line | 2151 E COMMERCIAL BLVD SUITE 202
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-3807
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Country | US
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Telephone | 954-431-8022
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Fax | 954-431-8078
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Provider Business Mailing Address
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Address Line | 2151 E COMMERCIAL BLVD SUITE 202
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-3807
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Country | US
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Telephone | 954-431-8022
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Fax | 954-431-8078
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VICTORIA MACATANGAY GAUS
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Credential | M.D.
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Telephone | 954-431-8022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | ME97569
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License Number State | FL
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