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Specialty details in registry · Pembroke Pines, FL

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At a glance

11040 Pines Blvd, Pembroke Pines, FL 33026-5209

NPPES record updated May 13, 2014. Public records can lag behind changes at a practice.

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Insurance participation and appointment availability are not established by these public records.

Practice location

11040 Pines Blvd
Pembroke Pines, FL 33026-5209

Professional details: NPI, taxonomy & registry record

NPI1033520044

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Registry details

Primary taxonomy: Specialty details in registry
Taxonomy code: 156FX1800X
Enumeration date: May 13, 2014
Record updated: May 13, 2014

More registry details

Provider type: Organization · Type 2

Reported taxonomies and licenses

Specialty details in registry

156FX1800X · Primary

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

11040 Pines Blvd
Pembroke Pines, FL 33026-5209

Phone: (954) 251-3745
Fax: (954) 505-7379

Mailing address

296 GRAYSON HWY

LAWRENCEVILLE, GA 300465737

Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.

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