1396139150 NPI number — HOLLYWOOD PRIMARY CARE

Table of content: (NPI 1396139150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396139150 NPI number — HOLLYWOOD PRIMARY CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOLLYWOOD PRIMARY CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HPC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396139150
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2301 N UNIVERSITY DR STE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEMBROKE PINES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33024-3617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-271-7180
Provider Business Mailing Address Fax Number:
954-900-8869

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2301 N UNIVERSITY DR STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEMBROKE PINES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33024-3617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-271-7180
Provider Business Practice Location Address Fax Number:
954-900-8869
Provider Enumeration Date:
03/19/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SALAZAR
Authorized Official First Name:
FRANCIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-271-7180

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X , with the licence number:  OS10490 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2500X , with the licence number: OS10490 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X , with the licence number: OS10490 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)