Provider Demographics
NPI:1114644002
Name:SOUTH FLORIDA HAIR RESTORATION
Entity Type:Organization
Organization Name:SOUTH FLORIDA HAIR RESTORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-592-5718
Mailing Address - Street 1:7710 NW 71ST CT STE 303
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2932
Mailing Address - Country:US
Mailing Address - Phone:954-960-5763
Mailing Address - Fax:954-586-4178
Practice Address - Street 1:7710 NW 71ST CT STE 303
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2932
Practice Address - Country:US
Practice Address - Phone:954-960-5763
Practice Address - Fax:954-586-4178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care