1649800335 NPI number — WP CROSSINGS SR-FL HOLDER, LLC

Table of content: DR. MIRELLA VASQUEZ BROOKS NP (NPI 1518231059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649800335 NPI number — WP CROSSINGS SR-FL HOLDER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WP CROSSINGS SR-FL HOLDER, LLC
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:
1649800335
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 E PALMETTO PARK RD STE 700
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33432-4829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-961-7923
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8451 US 301 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERVIEW
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33578-5450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-671-0222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2020

Additional Information

Authorized Official

Authorized Official Last Name:
ROCKEFELLER
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
RYAN
Authorized Official Title or Position:
CFO OF MGMT CO
Authorized Official Telephone Number:
727-581-4648

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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