Provider Demographics
NPI:1922598580
Name:PRIMARY CARE PHYSICIANS OF HOLLYWOOD, PA
Entity Type:Organization
Organization Name:PRIMARY CARE PHYSICIANS OF HOLLYWOOD, PA
Other - Org Name:PRIMARY CARE PHYSICIANS OF HOLLYWOOD, PL
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOISES
Authorized Official - Middle Name:A
Authorized Official - Last Name:ISSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-983-9191
Mailing Address - Street 1:2488 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3624
Mailing Address - Country:US
Mailing Address - Phone:954-983-9191
Mailing Address - Fax:954-983-1152
Practice Address - Street 1:2488 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3624
Practice Address - Country:US
Practice Address - Phone:954-983-9191
Practice Address - Fax:954-983-1152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty