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General NPI Number Information
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NPI Number | 1174718704
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Entity Type | Organization
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Legal Business Name | EAST HOLLYWOOD MEDICAL ASSOCIATES, INC.
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 08/23/2024
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Provider Practice Location Address
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Address Line | 3702 WASHINGTON ST STE 205
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City | HOLLYWOOD
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State | FL
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Zip | 33021-8283
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Country | US
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Telephone | 954-926-2900
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Fax | 954-926-2956
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Provider Business Mailing Address
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Address Line | 3702 WASHINGTON ST STE 205
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City | HOLLYWOOD
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State | FL
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Zip | 33021-8283
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Country | US
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Telephone | 954-926-2900
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Fax | 954-926-2956
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MANUEL IRIBAR
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Credential | M.D
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Telephone | 954-926-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | ME0041495
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License Number State | FL
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