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General NPI Number Information
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NPI Number | 1003312331
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Entity Type | Organization
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Legal Business Name | HOLLYWOOD CLINIC CORP
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Dates
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Enumeration Date | 04/04/2018
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Last Update Date | 04/04/2018
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Provider Practice Location Address
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Address Line | 5941 NW 173RD DR UNIT 7
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City | HIALEAH
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State | FL
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Zip | 33015-5110
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Country | US
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Telephone | 305-817-1424
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Fax | 305-817-1426
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Provider Business Mailing Address
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Address Line | 5941 NW 173RD DR UNIT 7
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City | HIALEAH
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State | FL
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Zip | 33015-5110
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Country | US
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Telephone | 305-817-1424
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Fax | 305-817-1426
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CELIA GONZALEZ
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Credential |
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Telephone | 786-547-4546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | HCC11111
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License Number State | FL
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