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General NPI Number Information
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NPI Number | 1841801297
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Entity Type | Organization
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Legal Business Name | MEMORIAL MEDICAL GROUP OF SOUTH FLORIDA
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Dates
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Enumeration Date | 08/10/2020
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 15800 PINES BLVD STE 325
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-1212
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Country | US
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Telephone | 754-273-0885
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Fax | 866-610-8782
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Provider Business Mailing Address
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Address Line | 16000 PINES BOULEVARD #822503
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City | PEMBROKE PINES
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State | FL
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Zip | 33082-2503
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Country | US
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Telephone | 754-273-0885
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Fax | 866-610-8782
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LISA B MARSHALL
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Credential | MPAS, PA-C
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Telephone | 754-273-0885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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