MEDICARE: FAMILY INVESTMENT & TRADE CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	G12000112470	FL
2	261QM1300X	Multi-Specialty Clinic/Center	G12000112470	FL

General Provider Information

NPI Number	:	1386980621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY INVESTMENT & TRADE CORP

Provider Business Mailing Address
First Line	:	6318 FOREST HILL BLVD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33415-6104
Country	:	US
Telephone Number	:	561-328-8025
Fax Number	:

Provider Business Practice Location Address
First Line	:	6318 FOREST HILL BLVD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33415-6104
Country	:	US
Telephone Number	:	561-328-8025
Fax Number	:

Authorized Official
Title or Position	:	COORDINATOR
Name	:	LENESE NAVAL
Credential	:
Telephone Number	:	561-328-8025

Provider Enumeration Date	:	12/13/2012
Last Update Date	:	12/13/2012

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