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General NPI Number Information
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NPI Number | 1649671744
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Entity Type | Organization
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Legal Business Name | CARDIOVASCULAR PREVENTATIVE CARE, LLC
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Dates
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Enumeration Date | 09/08/2014
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Last Update Date | 06/09/2015
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Provider Practice Location Address
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Address Line | 1 SW 129TH AVE SUITE 105
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-1761
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Country | US
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Telephone | 954-425-6200
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Fax | 941-460-4097
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Provider Business Mailing Address
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Address Line | 1 SW 129TH AVE SUITE 105
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-1761
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Country | US
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Telephone | 954-425-6200
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Fax | 941-460-4097
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Authorized Official
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Title or Position | MANAGER
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Name | DANIEL NORBERG
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Credential | MD
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Telephone | 954-425-6200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME64325
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License Number State | FL
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