Provider Demographics
NPI:1003312331
Name:HOLLYWOOD CLINIC CORP
Entity Type:Organization
Organization Name:HOLLYWOOD CLINIC CORP
Other - Org Name:SLEEP DISORDER DIAGNOSTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-547-4546
Mailing Address - Street 1:5941 NW 173RD DR UNIT 7
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5110
Mailing Address - Country:US
Mailing Address - Phone:305-817-1424
Mailing Address - Fax:305-817-1426
Practice Address - Street 1:5941 NW 173RD DR UNIT 7
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5110
Practice Address - Country:US
Practice Address - Phone:305-817-1424
Practice Address - Fax:305-817-1426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC11111261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty