Provider Demographics
NPI:1164968970
Name:PALM BEACH NEPHROLOGY PARTNERS LLC
Entity Type:Organization
Organization Name:PALM BEACH NEPHROLOGY PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:OTTINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-914-1277
Mailing Address - Street 1:13005 STATE ROAD 80
Mailing Address - Street 2:SUITE 141
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-9206
Mailing Address - Country:US
Mailing Address - Phone:561-798-4600
Mailing Address - Fax:561-798-1132
Practice Address - Street 1:13005 STATE ROAD 80
Practice Address - Street 2:SUITE 141
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9206
Practice Address - Country:US
Practice Address - Phone:561-798-4600
Practice Address - Fax:561-798-1132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111442207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty