=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770513681
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AL NISA INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2006
-----------------------------------------------------
Last Update Date | 08/27/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3939 HOLLYWOOD BLVD SUITE 3B
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33021-6749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-237-6409
-----------------------------------------------------
Fax | 954-272-6012
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3939 HOLLYWOOD BLVD SUITE 3B
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33021-6749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-237-6409
-----------------------------------------------------
Fax | 954-272-6012
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. JOSEFINA PATRICIA MUNAJJ
-----------------------------------------------------
Credential | ARNP/CNM
-----------------------------------------------------
Telephone | 954-237-6409
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | ARNP 2589502
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------