Provider Demographics
NPI:1255955357
Name:FED HELP MEDICAL OF WEST BROWARD CORP
Entity type:Organization
Organization Name:FED HELP MEDICAL OF WEST BROWARD CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YARISBEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-703-1605
Mailing Address - Street 1:11430 N KENDALL DR STE 106
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1041
Mailing Address - Country:US
Mailing Address - Phone:786-312-0359
Mailing Address - Fax:
Practice Address - Street 1:11430 N KENDALL DR STE 106
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1041
Practice Address - Country:US
Practice Address - Phone:786-312-0359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FED HELP MEDICAL OF WEST BROWARD CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-04
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)