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3317 Nw 10th Ter Ste 406 Fort Lauderdale FL 33309-5941 | |
| (786) 423-5459 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 3317 Nw 10th Ter Ste 406, Fort Lauderdale, Florida |
| Authorized Official Name and Position | C Gonzalez (CEO/OWNER) |
| Authorized Official Contact | 7864235459 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
20 Tam O Shanter Ln Boca Raton FL 33431-3903 Ph: (786) 423-5459 | 3317 Nw 10th Ter Ste 406 Fort Lauderdale FL 33309-5941 Ph: (786) 423-5459 |
| NPI Number | 1467907519 |
|---|---|
| Provider Enumeration Date | 08/18/2016 |
| Last Update Date | 08/18/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467907519 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 0050962014 (Florida) | Primary |
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