Healthcare Provider Details

I. General information

NPI: 1023896016
Provider Name (Legal Business Name): PHYSICIANS PARTNERSHIP ALLIANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10081 PINES BLVD STE B
PEMBROKE PINES FL
33024-6171
US

IV. Provider business mailing address

10081 PINES BLVD STE B
PEMBROKE PINES FL
33024-6171
US

V. Phone/Fax

Practice location:
  • Phone: 954-251-1175
  • Fax: 786-732-0460
Mailing address:
  • Phone: 954-251-1175
  • Fax: 786-732-0460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALBERTO MANZOR
Title or Position: DOCTOR
Credential: MD
Phone: 305-878-3072