MEDICARE: FXM CLINICAL RESEARCH FT LAUDERDALE LLC

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	261QR1100X	Research Clinic/Center

General Provider Information

NPI Number	:	1548810914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FXM CLINICAL RESEARCH FT LAUDERDALE LLC

Provider Business Mailing Address
First Line	:	11760 BIRD RD STE 452
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-3598
Country	:	US
Telephone Number	:	305-220-5222
Fax Number	:	305-675-3152

Provider Business Practice Location Address
First Line	:	4331 N FEDERAL HWY FL 4
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-5211
Country	:	US
Telephone Number	:	305-220-5222
Fax Number	:	305-675-3152

Authorized Official
Title or Position	:	CEO
Name	:	MARITZA D. DIEGO
Credential	:	PA-C
Telephone Number	:	305-220-5222

Provider Enumeration Date	:	09/17/2019
Last Update Date	:	09/17/2019

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