# PEMBROK HEALTH AND WELLNESS CENTER, LLC

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

## Provider details

- **NPI number:** 1548560733
- **Authorized official:** DR. MARK DEAN KORNHABER DO (MEDICAL DIRECTOR)
- **Authorized official phone:** (954) 499-4143

## Contact information

- **Practice address:** 12133 PEMBROKE ROAD, PEMBROKE PINES, FL 33025
- **Practice address phone:** (954) 499-4143
- **Practice address fax:** (954) 499-4146
- **Mailing address:** 12133 PEMBROKE ROAD, PEMBROKE PINES, FL 33025
- **Mailing address phone:** (954) 499-4143
- **Mailing address fax:** (954) 499-4146

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | FLOS4139 | FL | Yes |
| 208VP0014X | Interventional Pain Medicine Physician | FLOS4139 | FL | — |

## Other

- **Enumeration date:** 10/22/2010
- **Last updated:** 10/22/2010