Healthcare Provider Details

I. General information

NPI: 1780670901
Provider Name (Legal Business Name): PCM MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 E 9TH ST
HIALEAH FL
33010-4553
US

IV. Provider business mailing address

731 E 9TH ST
HIALEAH FL
33010-4553
US

V. Phone/Fax

Practice location:
  • Phone: 305-863-2060
  • Fax: 305-863-2027
Mailing address:
  • Phone: 305-863-2060
  • Fax: 305-863-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberHCC3708
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: MR. OSVALDO RICARDO
Title or Position: PRESIDENT
Credential:
Phone: 305-863-2060