MEDICARE: EAST HOLLYWOOD MEDICAL ASSOCIATES, INC.

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	ME0041495	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174718704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST HOLLYWOOD MEDICAL ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	3702 WASHINGTON ST STE 205
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-8283
Country	:	US
Telephone Number	:	954-926-2900
Fax Number	:	954-926-2956

Provider Business Practice Location Address
First Line	:	3702 WASHINGTON ST STE 205
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-8283
Country	:	US
Telephone Number	:	954-926-2900
Fax Number	:	954-926-2956

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MANUEL IRIBAR
Credential	:	M.D
Telephone Number	:	954-926-2900

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	08/23/2024

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