| Convenient Practitioner Services Pa | |
|
10641 Sw 37th Pl Davie FL 33328-1310 | |
| (954) 861-7522 | |
| (954) 916-9436 |
| Full Name | Convenient Practitioner Services Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 10641 Sw 37th Pl, Davie, Florida |
| Authorized Official Name and Position | Igdalis Roldan Christen (PRESIDENT) |
| Authorized Official Contact | 9548617522 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Convenient Practitioner Services Pa 10641 Sw 37th Pl Davie FL 33328-1310 Ph: (954) 861-7522 | Convenient Practitioner Services Pa 10641 Sw 37th Pl Davie FL 33328-1310 Ph: (954) 861-7522 |
| NPI Number | 1063656155 |
|---|---|
| Provider Enumeration Date | 04/21/2009 |
| Last Update Date | 04/21/2009 |
| Medicare PECOS PAC ID | 0345391801 |
|---|---|
| Medicare Enrollment ID | O20090624000307 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063656155 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ARNP1737192 (Florida) | Primary |
| 363LF0000X | Nurse Practitioner - Family | ARNP1737192 (Florida) | Secondary |
| Provider Name | Eric O Pantaleon |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1518997964 PECOS PAC ID: 7618965096 Enrollment ID: I20040604000128 |
| Provider Name | Igdalis Roldan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629012885 PECOS PAC ID: 6406816784 Enrollment ID: I20041012000565 |
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