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Organization
LAKESIDE MEDICAL AND AESTHETIC CENTRE LC
Active
Organization
LAKESIDE MEDICAL AND AESTHETIC CENTRE LC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYDIA FUXA (ADMINSTRATOR)
(954) 392-7157
Entity
Organization
Contact information
Practice address
600 N HIATUS RD, SUITE 203, PEMBROKE PINES, FL 33026-5207
(954) 392-7157
(954) 443-4941
Mailing address
600 N HIATUS RD, SUITE 203, PEMBROKE PINES, FL 33026-5207
(954) 392-7157
(954) 443-4941
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS7420
FL
207R00000X
Internal Medicine Physician
ME70790
FL
Other
Enumeration date
04/07/2008
Last updated
09/28/2015
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