1023484565 NPI number — THE HORMONE RESTORATION CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023484565 NPI number — THE HORMONE RESTORATION CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE HORMONE RESTORATION CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023484565
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12889 US HIGHWAY 98 W
Provider Second Line Business Mailing Address:
SUITE 107B
Provider Business Mailing Address City Name:
MIRAMAR BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32550-3243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-837-1271
Provider Business Mailing Address Fax Number:
850-460-2279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12889 HWY 98 W
Provider Second Line Business Practice Location Address:
SUITE 107B
Provider Business Practice Location Address City Name:
MIRAMAR BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-837-1271
Provider Business Practice Location Address Fax Number:
850-460-2279
Provider Enumeration Date:
08/19/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CHERN
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
850-837-1271

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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