Provider Demographics
NPI:1962454132
Name:WOMENS WELLNESS CENTER OF SOUTH FLORIDA LLC
Entity type:Organization
Organization Name:WOMENS WELLNESS CENTER OF SOUTH FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-984-8892
Mailing Address - Street 1:3850 COCONUT CREEK PKWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-1600
Mailing Address - Country:US
Mailing Address - Phone:954-984-8892
Mailing Address - Fax:954-984-8810
Practice Address - Street 1:3850 COCONUT CREEK PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33066-1600
Practice Address - Country:US
Practice Address - Phone:954-984-8892
Practice Address - Fax:954-984-8810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0728706OtherPARITY HEALTHCARE
FLK9889Medicare PIN
FLG28706Medicare UPIN