Healthcare Provider Details

I. General information

NPI: 1790178697
Provider Name (Legal Business Name): PHYSICIAN PARTNERSHIP ALLIANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2015
Last Update Date: 03/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3829 HOLLYWOOD BLVD STE A
HOLLYWOOD FL
33021-6790
US

IV. Provider business mailing address

3829 HOLLYWOOD BLVD STE A
HOLLYWOOD FL
33021-6790
US

V. Phone/Fax

Practice location:
  • Phone: 786-233-8722
  • Fax: 954-281-5440
Mailing address:
  • Phone: 786-233-8722
  • Fax: 954-281-5440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberME0080969
License Number StateFL

VIII. Authorized Official

Name: DR. F.M. ANTONIETA SCHETTINO
Title or Position: CHIEF MEDICAL OFFICER
Credential: M.D.
Phone: 786-233-8722