Healthcare Provider Details

I. General information

NPI: 1093348419
Provider Name (Legal Business Name): ANOTHER WAY 1, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 04/16/2020
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 DIVISION ST
RIVERSIDE CA
92506-3269
US

IV. Provider business mailing address

(TUTT) 1835 E. HALLANDALE BCH BLVD #127
HALLANDALE FL
33009
US

V. Phone/Fax

Practice location:
  • Phone: 951-368-0428
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ZANDRA BERNETA TUTT
Title or Position: CEO
Credential: MD
Phone: 954-937-2944