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General NPI Number Information
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NPI Number | 1891728119
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Entity Type | Organization
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Legal Business Name | PREVENTIVE HEALTH CENTER
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1001 N FEDERAL HWY SUITE #102
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-2400
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Country | US
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Telephone | 954-458-2559
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Fax | 954-457-1861
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Provider Business Mailing Address
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Address Line | 1001 N FEDERAL HWY SUITE #102
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-2400
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Country | US
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Telephone | 954-458-2559
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Fax | 954-457-1861
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Authorized Official
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Title or Position | GENERAL PRACTICE
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Name | DR. 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 | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | ME85417
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License Number State | FL
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