Provider Demographics
NPI:1093348419
Name:ANOTHER WAY 1, LLC
Entity Type:Organization
Organization Name:ANOTHER WAY 1, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ZANDRA
Authorized Official - Middle Name:BERNETA
Authorized Official - Last Name:TUTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-937-2944
Mailing Address - Street 1:(TUTT)
Mailing Address - Street 2:1835 E. HALLANDALE BCH BLVD #127
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5750 DIVISION ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3269
Practice Address - Country:US
Practice Address - Phone:951-368-0428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-13
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty