=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770052334
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KATALYST HEALTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2018
-----------------------------------------------------
Last Update Date | 06/11/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14704 SW 11 STREET
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-699-7696
-----------------------------------------------------
Fax | 954-206-6346
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14704 SW 11TH ST
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33027-6194
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-699-7696
-----------------------------------------------------
Fax | 954-206-6346
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MARIE DENISE ALVAREZ
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 954-699-7696
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0505X
-----------------------------------------------------
Taxonomy Name | Adult Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------