=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962898189
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN DABAKAROFF DPM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2015
-----------------------------------------------------
Last Update Date | 01/28/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4601 S UNIVERSITY DR
-----------------------------------------------------
City | DAVIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33328-3817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-680-7133
-----------------------------------------------------
Fax | 954-680-7135
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4601 S UNIVERSITY DR
-----------------------------------------------------
City | DAVIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33328-3817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-680-7133
-----------------------------------------------------
Fax | 954-680-7135
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213EP1101X
-----------------------------------------------------
Taxonomy Name | Primary Podiatric Medicine Podiatrist
-----------------------------------------------------
License Number | 3997
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------