Organization
LAKE'S MEDICAL OFFICE
Active
Organization
LAKE'S MEDICAL OFFICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MANUEL C ACOSTA OWNER (PRESIDENT)
(954) 961-8195
Entity
Organization
Contact information
Practice address
6260 JOHNSON ST, HOLLYWOOD, FL 33024-5932
(954) 961-8195
Mailing address
6260 JOHNSON ST, HOLLYWOOD, FL 33024-5932
(954) 961-8195
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
HCC4716
FL
Other
Enumeration date
07/19/2007
Last updated
07/19/2007
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