Provider Demographics
NPI:1790178697
Name:PHYSICIAN PARTNERSHIP ALLIANCE LLC
Entity Type:Organization
Organization Name:PHYSICIAN PARTNERSHIP ALLIANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:F.M.
Authorized Official - Middle Name:ANTONIETA
Authorized Official - Last Name:SCHETTINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-233-8722
Mailing Address - Street 1:3829 HOLLYWOOD BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6790
Mailing Address - Country:US
Mailing Address - Phone:786-233-8722
Mailing Address - Fax:954-281-5440
Practice Address - Street 1:3829 HOLLYWOOD BLVD
Practice Address - Street 2:STE A
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6790
Practice Address - Country:US
Practice Address - Phone:786-233-8722
Practice Address - Fax:954-281-5440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00809692083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL71292Medicare PIN