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General NPI Number Information
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NPI Number | 1639189392
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Entity Type | Organization
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Legal Business Name | UNIVERSITY INTERNAL MEDICINE OF PALM BEACH LLC
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 05/11/2011
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Provider Practice Location Address
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Address Line | 10151 ENTERPRISE CENTER BLVD SUITE 202
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-3759
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Country | US
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Telephone | 561-374-8811
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Fax | 561-374-8822
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Provider Business Mailing Address
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Address Line | PO BOX 480456
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City | DELRAY BEACH
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State | FL
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Zip | 33448-0456
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Country | US
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Telephone | 561-374-8811
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Fax | 561-374-8822
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Authorized Official
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Title or Position | MANAGER
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Name | DR. SONNY VAN NGUYEN
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Credential | M.D.
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Telephone | 561-374-8811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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