Healthcare Provider Details

I. General information

NPI: 1730947698
Provider Name (Legal Business Name): MY VIRTUAL CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 S OCEAN DR APT 1703
HALLANDALE BEACH FL
33009-7735
US

IV. Provider business mailing address

1890 S OCEAN DR APT 1703
HALLANDALE BEACH FL
33009-7735
US

V. Phone/Fax

Practice location:
  • Phone: 786-682-4084
  • Fax:
Mailing address:
  • Phone: 786-682-4084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSE LUIS RIVERA MENDEZ
Title or Position: MANAGER
Credential: MD
Phone: 786-682-4084