Lice Source Services, INC.
Clinic/Center, Primary Care in Plantation, FL. Organization (NPI-2).
NPI number1508092263
StatusActive
Last updated in NPPESOct 3, 2011
Details
- NPI
- 1508092263
- Entity type
- Organization (NPI-2)
- Legal business name
- Lice Source Services, INC.
- Organization subpart
- No
- Enumeration date
- Jun 8, 2009
- Last updated
- Oct 3, 2011
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QP2300X | Clinic/Center, Primary Care | HCC8589 | FL | Yes |
| 261Q00000X | Clinic/Center | HCC8589 | FL | |
| 261QH0100X | Clinic/Center, Health Services | HCC8589 | FL | |
| 261QM1300X | Clinic/Center, Multi-Specialty | HCC8589 | FL | |
| 261QS1000X | Clinic/Center, Student Health | HCC8589 | FL |
Other names
- South Florida Family Health & Research Centers (Doing Business As)
Practice location
6971 W Sunrise BlvdSuite #102
Plantation, FL 33313-4407
Phone 954-791-0711 · Fax 954-791-4392
Mailing address
6971 W Sunrise BlvdSuite #102
Plantation, FL 33313-4407
Phone 954-791-0711 · Fax 954-791-4392
Authorized official
Lidia E Serrano
Clinical Director
9547910711
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