# JUVENIS MEDICAL LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154043412
- **Authorized official:** PAUL GOODKIN (CEO)
- **Authorized official phone:** (954) 494-3711

## Contact information

- **Practice address:** 4750 N FEDERAL HWY STE 203, FORT LAUDERDALE, FL 33308-4609
- **Practice address phone:** (954) 494-3711
- **Practice address fax:** (954) 776-9953
- **Mailing address:** 4750 N FEDERAL HWY STE 203, FORT LAUDERDALE, FL 33308-4609
- **Mailing address phone:** (954) 494-3711
- **Mailing address fax:** (954) 776-9953

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 164W00000X | Licensed Practical Nurse | — | NULL | — |
| 164W00000X | Licensed Practical Nurse | — | — | — |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 09/14/2022
- **Last updated:** 09/14/2022