| NPI | 1013104645 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANITA GARIB Doctor 561-422-1003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL ME84607) |
| Additional Taxonomies | 305S00000X Point of Service (Licence: FL ME84607) |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2009-12-28 |