NPI 1124201991

Foot, Ankle & Leg Specialists

Organisation Non-Pharmacy Dispensing Site Pembroke Pines, FL

Practice location

Address: 17842 NW 2nd Street, Pembroke Pines, FL 33029
Phone: (954) 389-5900
Mailing address: 3607 Old Conejo Rd, Thousand Oaks, CA 91320-2123

Authorised official

Name: Augustine Bollo
Title: Physician
Phone: (954) 389-5900

Registered specialties

Non-Pharmacy Dispensing Site Primary

Suppliers Taxonomy 332900000X Licence PO02570 (FL)

Other Non-Pharmacy Dispensing Site providers in Florida →

Registry record

NPI: 1124201991
Entity type: Organization
NPI issued: 14 Dec 2007
Record last updated: 19 Dec 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.