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General NPI Number Information
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NPI Number | 1770509267
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Entity Type | Organization
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Legal Business Name | PREVENTIVE HEALTH CENTER INC
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 01/06/2009
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Provider Practice Location Address
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Address Line | 2500 E HALLANDALE BEACH BLVD SUITE 406
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4834
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Country | US
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Telephone | 954-458-2559
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Fax | 954-454-3833
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Provider Business Mailing Address
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Address Line | 2500 E HALLANDALE BEACH BLVD SUITE 406
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4834
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Country | US
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Telephone | 954-458-2559
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Fax | 954-454-3833
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Authorized Official
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Title or Position | PRESIDENT
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Name | LISSA M JEAN-PIERRE
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Credential | MD
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Telephone | 954-458-2559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME85417
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License Number State | FL
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