| 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 | This clinic does not participate in Medicare Program. |
| 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 |
| Certification Date | 08/19/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336484484 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME47178 (Florida) | Primary |
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