MEDICARE: PALM BEACH PRIMARY CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1225800584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALM BEACH PRIMARY CARE

Provider Business Mailing Address
First Line	:	14151 LITTLE CYPRESS CIR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33410-1118
Country	:	US
Telephone Number	:	561-531-8943
Fax Number	:

Provider Business Practice Location Address
First Line	:	14151 LITTLE CYPRESS CIR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33410-1118
Country	:	US
Telephone Number	:	561-531-8943
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANDRES DOMINGUEZ
Credential	:
Telephone Number	:	561-531-8943

Provider Enumeration Date	:	10/30/2023
Last Update Date	:	10/30/2023

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Directions to “PALM BEACH PRIMARY CARE ” Practice Location

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