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General NPI Number Information
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NPI Number | 1760836316
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Entity Type | Organization
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Legal Business Name | FLORIDA PREMIER CARDIOLOGY, LLC
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Dates
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Enumeration Date | 04/20/2016
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Last Update Date | 04/20/2016
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Provider Practice Location Address
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Address Line | 11195 S JOG RD STE 6
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-1830
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Country | US
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Telephone | 561-807-0500
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Fax | 866-214-6612
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Provider Business Mailing Address
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Address Line | 11195 S JOG RD STE 6
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-1830
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Country | US
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Telephone | 561-807-0500
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Fax | 866-214-6612
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Authorized Official
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Title or Position | MEMBER
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Name | RODOLFO CARRILLO-JIMENEZ
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Credential | MD
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Telephone | 561-807-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | ME82672
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License Number State | FL
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