121 Medical Center LLC
Internal Medicine in Fort Lauderdale, FL. Organization (NPI-2).
NPI number1982384814
StatusActive
Last updated in NPPESJun 27, 2025
Details
- NPI
- 1982384814
- Entity type
- Organization (NPI-2)
- Legal business name
- 121 Medical Center LLC
- Organization subpart
- Yes
- Enumeration date
- Jul 25, 2023
- Certification date
- Jun 27, 2025
- Last updated
- Jun 27, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | – | – | Yes |
Practice location
3333 W Commercial Blvd Ste 110Fort Lauderdale, FL 33309-3407
Phone 954-530-9770
Mailing address
11903 Southern Blvd Ste 108Royal Palm Beach, FL 33411-7644
Phone 561-793-1475
Authorized official
Rosny Simeon
Manager
5617931475
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