| South Broward Hospital District | |
|
1150 N 35th Ave Ste 525 Hollywood FL 33021-5431 | |
| (954) 265-6966 | |
| (954) 265-6950 |
| Full Name | South Broward Hospital District |
|---|---|
| Speciality | Psychologist |
| Location | 1150 N 35th Ave Ste 525, Hollywood, Florida |
| Authorized Official Name and Position | Nina Beauchesne (EXECUTIVE VICE PRESIDENT) |
| Authorized Official Contact | 9542653451 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Broward Hospital District 2900 Corporate Way Door D Miramar FL 33025-3925 Ph: (954) 276-5685 | South Broward Hospital District 1150 N 35th Ave Ste 525 Hollywood FL 33021-5431 Ph: (954) 265-6966 |
| NPI Number | 1013471614 |
|---|---|
| Provider Enumeration Date | 01/28/2019 |
| Last Update Date | 01/28/2019 |
| Medicare PECOS PAC ID | 8123927373 |
|---|---|
| Medicare Enrollment ID | O20191028002239 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013471614 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Ximena C Flanders |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1669723276 PECOS PAC ID: 3072845858 Enrollment ID: I20191028002548 |
| Provider Name | Lauren K Grodin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1003108077 PECOS PAC ID: 7113259466 Enrollment ID: I20191106000417 |
| Provider Name | Christina J Ortega |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1376950022 PECOS PAC ID: 4486934791 Enrollment ID: I20200212000105 |
| Provider Name | Edgardo Lopez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306337068 PECOS PAC ID: 7012348774 Enrollment ID: I20200513000286 |
| Provider Name | Michelle Brenes |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1720623648 PECOS PAC ID: 0840687836 Enrollment ID: I20220421000638 |
| Provider Name | Lazara A Novas |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1750708905 PECOS PAC ID: 3375900384 Enrollment ID: I20230607000963 |
| Provider Name | Juliana Yanguas |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1649870866 PECOS PAC ID: 6608226006 Enrollment ID: I20231227003084 |
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