MEDICARE: CENTRO DE SALUD PRIMARIA 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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1649706110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRO DE SALUD PRIMARIA LLC

Provider Business Mailing Address
First Line	:	4801 HOLLYWOOD BLVD
Second Line	:	SUITE B
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6545
Country	:	US
Telephone Number	:	954-927-5382
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 HOLLYWOOD BLVD
Second Line	:	SUITE B
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6545
Country	:	US
Telephone Number	:	954-927-5382
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ANDRES OZUAL
Credential	:	M.D.
Telephone Number	:	954-927-5382

Provider Enumeration Date	:	05/03/2017
Last Update Date	:	05/03/2017

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