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General NPI Number Information
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NPI Number | 1992974034
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Entity Type | Organization
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Legal Business Name | ADVANCED INSTITUTE OF OB GYN
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Dates
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Enumeration Date | 02/22/2008
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Last Update Date | 02/22/2008
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Provider Practice Location Address
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Address Line | 450 N PARK RD STE 202
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City | HOLLYWOOD
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State | FL
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Zip | 33021-6987
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Country | US
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Telephone | 954-983-2101
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Fax | 954-983-2860
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Provider Business Mailing Address
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Address Line | 450 N PARK RD STE 202
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City | HOLLYWOOD
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State | FL
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Zip | 33021-6987
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Country | US
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Telephone | 954-983-2101
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Fax | 954-983-2860
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELIAS JOSE MUALIN
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Credential | M.D.
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Telephone | 954-983-2101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME86605
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License Number State | FL
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