OrganizationActive
360 Medical PA
NPI 1508096330 · Nephrology Physician · Fort Lauderdale, FL
Provider details
- NPI number
- 1508096330
- Entity type
- Organization
- Primary specialty
- Nephrology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Lan Phan, President(954) 790-2251
- License
- OS7637 (FL)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
2004 Ne 49th St
Fort Lauderdale, FL 33308-4524
Phone: (954) 790-2251
Fax: (954) 206-2200
Approximate (ZIP-level) locationGet directions
Mailing address
2004 Ne 49th St
Fort Lauderdale, FL 33308-4524
Registry dates
- Enumerated
- 2009-07-14
- Last updated
- 2009-08-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.