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General NPI Number Information
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NPI Number | 1982384814
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Entity Type | Organization
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Legal Business Name | 121 MEDICAL CENTER LLC
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Dates
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Enumeration Date | 07/25/2023
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 3333 W COMMERCIAL BLVD STE 110
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-3407
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Country | US
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Telephone | 954-530-9770
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Fax |
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Provider Business Mailing Address
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Address Line | 11903 SOUTHERN BLVD STE 108
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City | ROYAL PALM BEACH
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State | FL
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Zip | 33411-7644
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Country | US
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Telephone | 561-793-1475
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ROSNY SIMEON
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Credential |
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Telephone | 561-793-1475
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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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