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NPI Code Detail

MEDICARE: PROVISION HEALTH INC.

MEDICARE: PROVISION HEALTH 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
1261Q00000XClinic/CenterHHC 8276FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1HHC 8276OTHERFLHEALTH CARE CLINIC

General Provider Information

NPI Number : 1285958058
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROVISION HEALTH INC.
Provider Business Mailing Address
First Line : 6916 NW 72ND AVE
Second Line :
City : MIAMI
State : FL
Zip : 33166-3036
Country : US
Telephone Number : 305-889-0188
Fax Number :
Provider Business Practice Location Address
First Line : 6916 NW 72ND AVE
Second Line :
City : MIAMI
State : FL
Zip : 33166-3036
Country : US
Telephone Number : 305-889-0188
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : JUAN CARLOS PEREZ
Credential :
Telephone Number : 305-889-0188
Provider Enumeration Date : 03/22/2010
Last Update Date : 03/22/2010

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