Healthcare Provider Details

I. General information

NPI: 1093597270
Provider Name (Legal Business Name): FAMILY FIRST MEDICAL RESEARCH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10550 NW 77TH CT STE 401
HIALEAH GARDENS FL
33016-2073
US

IV. Provider business mailing address

10550 NW 77TH CT STE 401
HIALEAH GARDENS FL
33016-2073
US

V. Phone/Fax

Practice location:
  • Phone: 786-665-9374
  • Fax: 888-269-3859
Mailing address:
  • Phone: 786-665-9374
  • Fax: 888-269-3859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TANIA PRIDA
Title or Position: OWNER
Credential:
Phone: 786-487-3987