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General NPI Number Information
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NPI Number | 1659976850
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Entity Type | Organization
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Legal Business Name | HEALTHY SENIORS MEDICAL HOLDINGS LLC
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Dates
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Enumeration Date | 12/03/2020
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 515 E LAS OLAS BLVD STE 120
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City | FT LAUDERDALE
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State | FL
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Zip | 33301-4261
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Country | US
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Telephone | 954-787-8874
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Fax | 561-584-7505
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Provider Business Mailing Address
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Address Line | 2199 NE 5TH AVE
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City | BOCA RATON
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State | FL
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Zip | 33431-7610
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Country | US
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Telephone | 561-702-1299
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Fax | 561-584-7505
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Authorized Official
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Title or Position | CEO
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Name | CHRISTOPHER J PETTAS
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Credential |
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Telephone | 561-702-1299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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