Basic Information
| Provider Information | |||||||||
| NPI: | 1497120513 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALPHA VECTOR LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2637 E ATLANTIC BLVD # 35722 | ||||||||
| Address2: | |||||||||
| City: | POMPANO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330624939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545430237 | ||||||||
| FaxNumber: | 8777632948 | ||||||||
| Practice Location | |||||||||
| Address1: | 5900 COLLEGE RD | ||||||||
| Address2: | |||||||||
| City: | KEY WEST | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330404342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052945531 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2015 | ||||||||
| LastUpdateDate: | 12/01/2015 | ||||||||
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| AuthorizedOfficialLastName: | VINER | ||||||||
| AuthorizedOfficialFirstName: | KIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2487012317 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | ME90584 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.