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General NPI Number Information
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NPI Number | 1942988613
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Entity Type | Organization
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Legal Business Name | KETAMINE CLINIC SOUTH FLORIDA
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Dates
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Enumeration Date | 07/11/2023
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 41 N FEDERAL HWY STE A
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City | POMPANO BEACH
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State | FL
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Zip | 33062-4304
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Country | US
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Telephone | 954-320-4944
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Fax | 954-400-5805
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Provider Business Mailing Address
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Address Line | 41 N FEDERAL HWY STE A
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City | POMPANO BEACH
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State | FL
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Zip | 33062-4304
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Country | US
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Telephone | 954-320-4944
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Fax | 954-400-5805
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Authorized Official
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Title or Position | PARTNER
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Name | KHALIUN CHULUUN REED
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Credential | APRN
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Telephone | 305-331-7149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 364SP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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