MEDICARE: BLESS MEDICAL CENTER HOLLYWOOD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1104436948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLESS MEDICAL CENTER HOLLYWOOD LLC

Provider Business Mailing Address
First Line	:	440 E SAMPLE RD
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-4444
Country	:	US
Telephone Number	:	954-864-6401
Fax Number	:

Provider Business Practice Location Address
First Line	:	6448 PEMBROKE RD
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33023-2138
Country	:	US
Telephone Number	:	954-864-6401
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	OSVALDO S MARTINEZ
Credential	:
Telephone Number	:	954-864-6401

Provider Enumeration Date	:	08/06/2020
Last Update Date	:	08/06/2020

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