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General NPI Number Information
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NPI Number | 1760555213
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Entity Type | Organization
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Legal Business Name | MODERN TIMES WOMENS CARE PA
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 03/31/2011
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Provider Practice Location Address
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Address Line | 7050 NW 4TH ST SUITE 201
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City | PLANTATION
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State | FL
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Zip | 33317-2247
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Country | US
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Telephone | 954-791-3090
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Fax | 954-921-3166
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Provider Business Mailing Address
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Address Line | 7050 NW 4TH ST SUITE 201
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City | PLANTATION
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State | FL
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Zip | 33317-2247
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Country | US
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Telephone | 954-791-3090
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Fax | 954-921-3166
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IDALIA TALAVERA
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Credential | M.D.
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Telephone | 954-921-3090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME85186
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License Number State | FL
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