LA CLINIQUE 300 INC NPI 1689059453

NPI Information

  • NPI: 1689059453
  • Provider Name: LA CLINIQUE 300 INC
  • Classification: Clinic/Center - 261Q00000X
  • Entity Type: Organization
  • Doing Business As: JOSEPH FANFAN JR MD PA
  • Address: 2630 N ANDREWS AVE
    WILTON MANORS, FL
    ZIP 33311
  • Phone: (954) 525-4900

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NPI Details

LA CLINIQUE 300 INC is a clinic center in Wilton Manors, FL. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). LA CLINIQUE 300 INC NPI is 1689059453. The provider is registered as an organization entity type.
The provider Is Doing Business As Joseph Fanfan Jr Md Pa.

The provider's business location address is:

2630 N ANDREWS AVE
WILTON MANORS, FL
ZIP 33311-550
Phone: (954) 525-4900
Fax: (954) 396-3110

The provider's authorized official is Joseph Fanfan .
The authorized official title is President and has the following contact phone number (954) 525-4900.

The enumeration date for this NPI number is 7/22/2015 and was last updated on 5/9/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261Q00000XClinic/CenterME43065FLYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1068166100MEDICAIDFLORIDA
294236MEDICARE PINFLORIDA
3D63170MEDICARE UPINFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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