Healthcare Provider Details

I. General information

NPI: 1891317806
Provider Name (Legal Business Name): SOCORRO HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E 25TH ST STE 308
HIALEAH FL
33013-3824
US

IV. Provider business mailing address

10640 SW 20TH CT
MIRAMAR FL
33025-3963
US

V. Phone/Fax

Practice location:
  • Phone: 954-696-3093
  • Fax: 305-995-0947
Mailing address:
  • Phone: 954-696-3093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CIOMARA SOCORRO
Title or Position: OWNER
Credential: ARNP
Phone: 954-696-3093