Provider Demographics
NPI:1992578611
Name:PHYTOGENICS CLINIC
Entity type:Organization
Organization Name:PHYTOGENICS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FUNCTIONAL MEDICINE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JOELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOLIERE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, MPH, FAARFM
Authorized Official - Phone:954-612-5831
Mailing Address - Street 1:4501 NW 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3403
Mailing Address - Country:US
Mailing Address - Phone:754-223-7701
Mailing Address - Fax:754-300-5998
Practice Address - Street 1:4501 NW 31ST AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33309-3403
Practice Address - Country:US
Practice Address - Phone:754-223-7701
Practice Address - Fax:754-300-5998
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYTOGENICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health