Provider Demographics
NPI:1558143768
Name:NORTHSTAR PPEC LLC
Entity Type:Organization
Organization Name:NORTHSTAR PPEC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINITRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-757-5005
Mailing Address - Street 1:3521 W BROWARD BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33312-1028
Mailing Address - Country:US
Mailing Address - Phone:954-530-9154
Mailing Address - Fax:954-530-9147
Practice Address - Street 1:3521 W BROWARD BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33312-1028
Practice Address - Country:US
Practice Address - Phone:954-530-9154
Practice Address - Fax:954-530-9147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center