# FLORIDA ATLANTIC UNIVERSITY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Florida Atlantic University Alzheimer's Prevention Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053736405
- **Authorized official:** LOUISA PONTIROLI-KELLY (AUTHORIZED OFFICIAL)
- **Authorized official phone:** (561) 297-2897

## Contact information

- **Practice address:** 777 GLADES RD, OFFICE BUILDING 1, BOCA RATON, FL 33431-6496
- **Practice address phone:** (561) 566-5328
- **Practice address fax:** (561) 299-4220
- **Mailing address:** 777 GLADES RD, OFFICE BUILDING 1, BOCA RATON, FL 33431-6496
- **Mailing address phone:** (561) 566-5328
- **Mailing address fax:** (561) 299-4220

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 311500000X | Alzheimer Center (Dementia Center) | — | NULL | Yes |

## Other

- **Enumeration date:** 02/21/2014
- **Last updated:** 04/23/2023