Provider Demographics
NPI:1427139328
Name:PRETTELT CENTER FOR FAMILY HEALTH PA
Entity type:Organization
Organization Name:PRETTELT CENTER FOR FAMILY HEALTH PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:E
Authorized Official - Last Name:PRETTELT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-333-5022
Mailing Address - Street 1:13475 SOUTHERN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-9203
Mailing Address - Country:US
Mailing Address - Phone:561-333-5022
Mailing Address - Fax:561-333-0449
Practice Address - Street 1:12955 PALMS WEST DR
Practice Address - Street 2:#101
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4993
Practice Address - Country:US
Practice Address - Phone:561-333-5022
Practice Address - Fax:561-333-0449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71770207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
32361AMedicare ID - Type Unspecified