Provider Demographics
NPI:1205156304
Name:MEMORIAL REGIONAL HOSPITAL HOLLYWOOD FLORIDA
Entity type:Organization
Organization Name:MEMORIAL REGIONAL HOSPITAL HOLLYWOOD FLORIDA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SURGICAL ASSISTANT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:SEGURA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:954-249-7581
Mailing Address - Street 1:1150 SW 189TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-6050
Mailing Address - Country:US
Mailing Address - Phone:954-450-0399
Mailing Address - Fax:
Practice Address - Street 1:1150 SW 189TH AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-6050
Practice Address - Country:US
Practice Address - Phone:954-450-0399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9292534282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital