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General NPI Number Information
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NPI Number | 1922814045
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Entity Type | Organization
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Legal Business Name | PREMIERMD QUALITY CARE LLC
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 3465 GALT OCEAN DR STE 202
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City | FT LAUDERDALE
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State | FL
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Zip | 33308-7077
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Country | US
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Telephone | 954-947-1773
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11457
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City | FORT LAUDERDALE
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State | FL
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Zip | 33339-1457
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Country | US
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Telephone | 954-947-1773
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VICTOR TOLEDANO
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Credential | MD
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Telephone | 954-947-1773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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