Healthcare Provider Details

I. General information

NPI: 1831689512
Provider Name (Legal Business Name): PRIMARY CARE PHYSICIANS OF HOLLYWOOD, PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 05/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8880 ROYAL PALM BLVD STE 105
CORAL SPRINGS FL
33065-5727
US

IV. Provider business mailing address

2488 N UNIVERSITY DR
PEMBROKE PINES FL
33024-3624
US

V. Phone/Fax

Practice location:
  • Phone: 954-983-9191
  • Fax: 954-983-1152
Mailing address:
  • Phone: 954-983-9191
  • Fax: 954-983-1152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MOISES A ISSA
Title or Position: PRESIDENT
Credential: MD
Phone: 954-983-9191