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2501 E Commercial Blvd Suite 211 Fort Lauderdale FL 33308-4127 | |
| (954) 320-3300 | |
| (954) 772-7182 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 2501 E Commercial Blvd, Fort Lauderdale, Florida |
| Authorized Official Name and Position | Alexander Fernandez (SVP/CFO) |
| Authorized Official Contact | 9544737315 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 862851 Orlando FL 32886-2851 Ph: (954) 847-4273 | 2501 E Commercial Blvd Suite 211 Fort Lauderdale FL 33308-4127 Ph: (954) 320-3300 |
| NPI Number | 1205153509 |
|---|---|
| Provider Enumeration Date | 04/26/2010 |
| Last Update Date | 05/25/2021 |
| Certification Date | 05/25/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205153509 | NPI | - | NPPES |
| 00020 | Other | FL | BCBS |
| 253794001 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | ME 72194 (Florida) | Primary |
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