Provider Demographics
NPI:1952110546
Name:PSE MEDICAL CENTER GROUP INC
Entity type:Organization
Organization Name:PSE MEDICAL CENTER GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IVETTE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ESPINOSA FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-479-4807
Mailing Address - Street 1:4320 W BROWARD BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-3756
Mailing Address - Country:US
Mailing Address - Phone:305-479-4807
Mailing Address - Fax:
Practice Address - Street 1:4320 W BROWARD BLVD STE 6
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-3756
Practice Address - Country:US
Practice Address - Phone:305-479-4807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center