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General NPI Number Information
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NPI Number | 1811441306
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Entity Type | Organization
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Legal Business Name | BROWARD MEDICAL AND WELLNESS
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Dates
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Enumeration Date | 08/12/2016
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Last Update Date | 08/12/2016
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Provider Practice Location Address
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Address Line | 2250 PALM BEACH LAKES BLVD SUITE 106
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-3407
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Country | US
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Telephone | 561-939-2710
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Fax |
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Provider Business Mailing Address
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Address Line | 2250 PALM BEACH LAKES BLVD SUITE 106
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-3407
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Country | US
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Telephone | 561-939-2710
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANETA DADASHEV
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Credential | PA
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Telephone | 305-904-6310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | PA9104589
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License Number State | FL
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