Provider Demographics
NPI:1578791547
Name:HAUGHTON, PAULINE L (LMT)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:L
Last Name:HAUGHTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-7307
Mailing Address - Country:US
Mailing Address - Phone:305-490-7254
Mailing Address - Fax:954-903-4845
Practice Address - Street 1:1170 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-7307
Practice Address - Country:US
Practice Address - Phone:305-490-7254
Practice Address - Fax:954-903-4845
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA56320174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist