=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992010383
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTERPOINT MEDICAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2010
-----------------------------------------------------
Last Update Date | 01/23/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4152 W BLUE HERON BLVD 123
-----------------------------------------------------
City | RIVIERA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33404-4811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-844-7699
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13420 DOUBLETREE CIR
-----------------------------------------------------
City | WELLINGTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33414-4006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-506-9754
-----------------------------------------------------
Fax | 561-842-8261
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MONICA WALKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-844-7699
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------