Provider Demographics
NPI:1649706110
Name:CENTRO DE SALUD PRIMARIA LLC
Entity type:Organization
Organization Name:CENTRO DE SALUD PRIMARIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:
Authorized Official - Last Name:OZUAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-927-5382
Mailing Address - Street 1:4801 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6545
Mailing Address - Country:US
Mailing Address - Phone:954-927-5382
Mailing Address - Fax:
Practice Address - Street 1:4801 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6545
Practice Address - Country:US
Practice Address - Phone:954-927-5382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty