MEDICARE: PHYSICIANS OF HOLLYWOOD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1144856626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS OF HOLLYWOOD LLC

Provider Business Mailing Address
First Line	:	5201 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6422
Country	:	US
Telephone Number	:	954-228-6619
Fax Number	:

Provider Business Practice Location Address
First Line	:	5201 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6422
Country	:	US
Telephone Number	:	954-716-9114
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MANUEL GONZALEZ
Credential	:	MD
Telephone Number	:	954-228-6619

Provider Enumeration Date	:	03/17/2020
Last Update Date	:	02/05/2026

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Directions to “PHYSICIANS OF HOLLYWOOD LLC ” Practice Location

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