| Llc | |
|
1855 N Corporate Lakes Blvd Ste 1 Weston FL 33326-3274 | |
| (954) 659-9690 | |
| (954) 659-9694 |
| Full Name | Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1855 N Corporate Lakes Blvd Ste 1, Weston, Florida |
| Authorized Official Name and Position | Carlos De Solo (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 3056498100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Llc 1000 Nw 57th Ct Ste 400 Miami FL 33126-3292 Ph: (305) 649-8100 | Llc 1855 N Corporate Lakes Blvd Ste 1 Weston FL 33326-3274 Ph: (954) 659-9690 |
| NPI Number | 1336484484 |
|---|---|
| Provider Enumeration Date | 11/30/2012 |
| Last Update Date | 08/19/2024 |
| Medicare PECOS PAC ID | 1355589607 |
|---|---|
| Medicare Enrollment ID | O20130529000365 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336484484 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME47178 (Florida) | Primary |
| Provider Name | Noel Mora |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538196258 PECOS PAC ID: 2769436377 Enrollment ID: I20050308000022 |
| Provider Name | Diana L. Suarez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275580789 PECOS PAC ID: 2961414024 Enrollment ID: I20060608000216 |
| Provider Name | Lee E Brown |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164609210 PECOS PAC ID: 4183701824 Enrollment ID: I20080407000022 |
| Provider Name | Mohsin H Jaffer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760531461 PECOS PAC ID: 3870644685 Enrollment ID: I20111019000671 |
| Provider Name | Sondra Aiken |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073750352 PECOS PAC ID: 0749437036 Enrollment ID: I20120905000772 |
| Provider Name | Adriana M Velasquez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659519361 PECOS PAC ID: 6002087202 Enrollment ID: I20130306000260 |
| Provider Name | Eduardo G Dedos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336544105 PECOS PAC ID: 6406173368 Enrollment ID: I20150402001499 |
| Provider Name | Rodolfo Herrera Barter |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1235529116 PECOS PAC ID: 6103116694 Enrollment ID: I20161111001445 |
| Provider Name | Maria A Jaimes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427497734 PECOS PAC ID: 7618256397 Enrollment ID: I20161121001776 |
| Provider Name | Alena Diaz De La Nuez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982002705 PECOS PAC ID: 2264826759 Enrollment ID: I20220226000109 |
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