Provider Demographics
NPI:1003911223
Name:UNITED BAPTIST GROUP OF BROWARD
Entity Type:Organization
Organization Name:UNITED BAPTIST GROUP OF BROWARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CRISTOBAL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-478-6299
Mailing Address - Street 1:14359 MIRAMAR PKWY
Mailing Address - Street 2:SUITE 347
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4134
Mailing Address - Country:US
Mailing Address - Phone:954-478-6299
Mailing Address - Fax:
Practice Address - Street 1:14359 MIRAMAR PKWY
Practice Address - Street 2:SUITE 347
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4134
Practice Address - Country:US
Practice Address - Phone:954-478-6299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty