=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649565888
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUALITY CARE FOR WOMEN LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2011
-----------------------------------------------------
Last Update Date | 04/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 N FLAMINGO RD SUITE 317
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33028-1015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-302-9078
-----------------------------------------------------
Fax | 877-261-9431
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 621 RANCH RD
-----------------------------------------------------
City | WESTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33326-1722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-762-7031
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | YARA DELGADO-SPASIC
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 954-762-7031
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | ME 99385
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------