Healthcare Provider Details

I. General information

NPI: 1710434485
Provider Name (Legal Business Name): PRIMECARE FAMILY CENTERS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4131 SW 6TH ST
CORAL GABLES FL
33134-2057
US

IV. Provider business mailing address

1914 NW 84TH AVE
DORAL FL
33126-1030
US

V. Phone/Fax

Practice location:
  • Phone: 305-442-2228
  • Fax: 305-442-2207
Mailing address:
  • Phone: 305-442-2228
  • Fax: 305-442-2207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME43821
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME45472
License Number StateFL

VIII. Authorized Official

Name: NERELYS PEREZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 305-442-2228