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General NPI Number Information
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NPI Number | 1730424763
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Entity Type | Organization
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Legal Business Name | BRIGHT MEDCARE LLC
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Dates
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Enumeration Date | 12/03/2012
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Last Update Date | 12/03/2012
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Provider Practice Location Address
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Address Line | 2544 N STATE ROAD 7
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City | HOLLYWOOD
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State | FL
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Zip | 33021-3205
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Country | US
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Telephone | 954-963-1899
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Fax | 954-963-5613
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Provider Business Mailing Address
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Address Line | 2544 N STATE ROAD 7
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City | HOLLYWOOD
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State | FL
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Zip | 33021-3205
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Country | US
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Telephone | 954-963-1899
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Fax | 954-963-5613
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Authorized Official
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Title or Position | MBR
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Name | MARK CERECEDA
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Credential | D.C,
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Telephone | 954-963-1899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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