=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790649085
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVERTRUST MEDICAL GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2025
-----------------------------------------------------
Last Update Date | 12/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3415 PINEWALK DR N
-----------------------------------------------------
City | MARGATE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33063-7777
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-359-7673
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3415 PINEWALK DR N
-----------------------------------------------------
City | MARGATE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33063-7777
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-359-7673
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | JACQUELINE LAGUERRE DURAZIL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-561-4711
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------