Organization
FLORIDA MEDICAL AND DIAGNOSTIC CENTER
Active
Other names
FLORIDA MEDICAL AND DIAGNOSTIC CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BOGOMOLOVA YULIA (MEDICAL DIRECTOR)
(954) 302-3048
Entity
Organization
Contact information
Practice address
3020 NE 32ND AVE STE 305, FORT LAUDERDALE, FL 33308-7204
(954) 302-3048
(718) 554-1666
Mailing address
3020 NE 32ND AVE STE 305, FORT LAUDERDALE, FL 33308-7204
(954) 302-3048
(718) 554-1666
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9238727
LIC
FL
Enumeration date
06/19/2019
Last updated
06/19/2019
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