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NPI Code Detail

MEDICARE: PROSPER MEDICAL OFFICE CORP.

MEDICARE: PROSPER MEDICAL OFFICE CORP.
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
1225200000XPhysical Therapy Assistant
2261QP2000XPhysical Therapy Clinic/Center
3363LF0000XFamily Nurse Practitioner
4207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1396585774
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROSPER MEDICAL OFFICE CORP.
Provider Business Mailing Address
First Line : 1150 NW 72ND AVE STE 377
Second Line :
City : MIAMI
State : FL
Zip : 33126-1920
Country : US
Telephone Number : 305-457-0444
Fax Number :
Provider Business Practice Location Address
First Line : 1150 NW 72ND AVE STE 377
Second Line :
City : MIAMI
State : FL
Zip : 33126-1920
Country : US
Telephone Number : 305-457-0444
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MR. RUBEN GONZALEZ
Credential : PTA
Telephone Number : 305-457-0444
Provider Enumeration Date : 05/31/2024
Last Update Date : 08/14/2024

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Directions to “PROSPER MEDICAL OFFICE CORP. ” Practice Location

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