Basic Information
| Provider Information | |||||||||
| NPI: | 1407249881 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PALM BEACH MEDICAL PRACTITIONERS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 416 CLEMATIS ST | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334015312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613295019 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1501 PRESIDENTIAL WAY STE 20 | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334011852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616163939 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2015 | ||||||||
| LastUpdateDate: | 04/26/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/14/2017 | ||||||||
| NPIReactivationDate: | 03/30/2017 | ||||||||
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| AuthorizedOfficialLastName: | POSADA | ||||||||
| AuthorizedOfficialFirstName: | NELSON | ||||||||
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| AuthorizedOfficialTitleorPosition: | ANDIMISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5613295019 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 04/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Contractor |
No ID Information.