MEDICARE: HUMANA CARE CENTER 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1326095456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUMANA CARE CENTER INC

Provider Business Mailing Address
First Line	:	4715 NW 157TH ST
Second Line	:	SUITE 107
City	:	HIALEAH
State	:	FL
Zip	:	33014-6435
Country	:	US
Telephone Number	:	305-628-2177
Fax Number	:	305-628-2178

Provider Business Practice Location Address
First Line	:	4715 NW 157TH ST
Second Line	:	SUITE 107
City	:	HIALEAH
State	:	FL
Zip	:	33014-6435
Country	:	US
Telephone Number	:	305-628-2177
Fax Number	:	305-628-2178

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PEDRO EDUARDO GONZALEZ
Credential	:
Telephone Number	:	305-628-2177

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	08/22/2020

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Directions to “HUMANA CARE CENTER INC ” Practice Location

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