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institution
Provita Physician Group Corp
Clinic/Center in Hollywood, Florida
NPI 1992435622

Provita Physician Group Corp is a Clinic/Center based in Hollywood, FL. Provita Physician Group Corp practices in Hollywood, FL. The NPI Number for Provita Physician Group Corp is 1992435622 and holds a License No. (Florida).

The current practice location address for Provita Physician Group Corp is 3157 N University Dr Ste 103, Hollywood, FL and can be reached out via phone at 954-322-8985 and via fax at 954-322-8981.

Location: 3157 N University Dr Ste 103, Hollywood, FL, 33024-2258
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1992435622
Provider Name
Provita Physician Group Corp
Credential
Provider Entity Type
Organization
Address
3157 N University Dr Ste 103, Hollywood, FL, 33024-2258
Phone Number
954-322-8985
Fax Number
954-322-8981
Provider Enumeration Date
06/15/2022
Last Update Date
03/13/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
15388808 01 FL CAQH
APRN9243523 01 FL MEDICAL LICENSE
institution
Provider Business Practice Location Address Details
Address
3157 N University Dr Ste 103
City
Hollywood
State
Florida
Zip
33024-2258
Phone Number
954-322-8985
Fax Number
954-322-8981
person
Provider Business Mailing Address Details
Address
3157 N University Dr Ste 103
City
Hollywood
State
Florida
Zip
33024-2258
Phone Number
954-322-8985
Fax Number
954-322-8981
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
-
Taxonomy
261Q00000X
License No.
()
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
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