MEDICARE: PROFESSIONAL SOLUTION GRP INC

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	261Q00000X	Clinic/Center		FL

General Provider Information

NPI Number	:	1245278266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL SOLUTION GRP INC

Provider Business Mailing Address
First Line	:	3250 W 16TH AVE
Second Line	:	NO. 208
City	:	HIALEAH
State	:	FL
Zip	:	33012-4606
Country	:	US
Telephone Number	:	786-308-8065
Fax Number	:

Provider Business Practice Location Address
First Line	:	3250 W 16TH AVE
Second Line	:	NO. 208
City	:	HIALEAH
State	:	FL
Zip	:	33012-4606
Country	:	US
Telephone Number	:	786-308-8065
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. GLADYS GOMEZ
Credential	:
Telephone Number	:	786-308-8065

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	08/22/2020

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Directions to “PROFESSIONAL SOLUTION GRP INC ” Practice Location

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