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17900 Nw 5th St Ste 202 Pembroke Pines FL 33029-2809 | |
| (954) 800-1408 | |
| (954) 842-4966 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 17900 Nw 5th St Ste 202, Pembroke Pines, Florida |
| Authorized Official Name and Position | Vitra Nishi Gosine (MEDICAL DOCTOR/OWNER) |
| Authorized Official Contact | 9548001408 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
17900 Nw 5th St Ste 202 Pembroke Pines FL 33029-2809 Ph: (954) 800-1408 | 17900 Nw 5th St Ste 202 Pembroke Pines FL 33029-2809 Ph: (954) 800-1408 |
| NPI Number | 1598300741 |
|---|---|
| Provider Enumeration Date | 11/12/2019 |
| Last Update Date | 04/08/2020 |
| Medicare PECOS PAC ID | 6507296332 |
|---|---|
| Medicare Enrollment ID | O20200420000706 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598300741 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | (* (Not Available)) | Primary |
| Provider Name | Vitra Gosine |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1376736181 PECOS PAC ID: 3678646676 Enrollment ID: I20080724000361 |
| Provider Name | Sheryl M Raikes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932433356 PECOS PAC ID: 9739229675 Enrollment ID: I20091228000184 |
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