Provider Demographics
NPI:1558744029
Name:VENETIAN ISLE MEDICAL OB/GYN CONSULTANTS ,INC
Entity Type:Organization
Organization Name:VENETIAN ISLE MEDICAL OB/GYN CONSULTANTS ,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:954-456-4888
Mailing Address - Street 1:3001 W HALLANDALE BEACH BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5155
Mailing Address - Country:US
Mailing Address - Phone:954-456-4888
Mailing Address - Fax:954-456-9721
Practice Address - Street 1:3001 W HALLANDALE BEACH BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:HALLANDALE
Practice Address - State:FL
Practice Address - Zip Code:33009-5155
Practice Address - Country:US
Practice Address - Phone:954-456-4888
Practice Address - Fax:954-456-9721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9409101367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty