Healthcare Provider Details

I. General information

NPI: 1437652500
Provider Name (Legal Business Name): PHYSICIANS ON CALL I CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 09/23/2019
Certification Date:
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 Code208M00000X
TaxonomyHospitalist Physician
License NumberME
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberME109374
License Number StateFL

VIII. Authorized Official

Name: DR. ALBERTO MANZOR
Title or Position: MD/OWNER
Credential: MD
Phone: 786-237-6666