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10794 Pines Blvd Ste 102 Pembroke Pines FL 33026-3920 | |
| (954) 431-8558 | |
| (954) 431-3867 |
| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 10794 Pines Blvd, Pembroke Pines, Florida |
| Authorized Official Name and Position | Mario Donald Zambrano (ATTENDING PHYSICIAN/CEO) |
| Authorized Official Contact | 9544318558 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
10794 Pines Blvd Ste 102 Pembroke Pines FL 33026-3920 Ph: (954) 431-8558 | 10794 Pines Blvd Ste 102 Pembroke Pines FL 33026-3920 Ph: (954) 431-8558 |
| NPI Number | 1336539303 |
|---|---|
| Provider Enumeration Date | 01/29/2015 |
| Last Update Date | 10/20/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336539303 | NPI | - | NPPES |
| G151181 | Other | FL | UPIN |
| 1750832366 | Other | FL | NPI |
| 1336539303 | Other | FL | GROUP NPI |
| 1508815531 | Other | FL | NPI |
| 378700100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | ME068860 (Florida) | Primary |
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