Unknown Individual – Physician Assistant, NPI 1235258443
Physician Assistant
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Unknown Individual
4780 SW 64TH AVE STE 103
DAVIE, FL 333144400
Phone: (954) 434-1705
Fax: (954) 450-8502
Type: Mailing
2004 N FLAMINGO RD
PEMBROKE PINES, FL 330283500
Phone: (954) 450-8500
Fax: (954) 450-8502
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 33314)
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