=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760799613
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POLYCLINIQUE DE WESTPALM BEACH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2010
-----------------------------------------------------
Last Update Date | 09/13/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 734 BELVEDERE RD
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33405-1108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-835-8385
-----------------------------------------------------
Fax | 561-835-4077
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 734 BELVEDERE ROAD
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-835-8385
-----------------------------------------------------
Fax | 561-835-4077
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. IRENE FIGARO
-----------------------------------------------------
Credential | RN BSN
-----------------------------------------------------
Telephone | 561-835-8385
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME43888
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------