MEDICARE: PROFESSIONAL COACHING ADVOCATES LLC

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	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1720975923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL COACHING ADVOCATES LLC

Provider Business Mailing Address
First Line	:	6014 SW 160TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-5809
Country	:	US
Telephone Number	:	786-397-9758
Fax Number	:	305-397-1797

Provider Business Practice Location Address
First Line	:	6014 SW 160TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-5809
Country	:	US
Telephone Number	:	786-397-9758
Fax Number	:	786-397-9758

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSE CARBONELL
Credential	:
Telephone Number	:	786-397-9758

Provider Enumeration Date	:	06/20/2025
Last Update Date	:	07/21/2025

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