Healthcare Provider Details

I. General information

NPI: 1497098024
Provider Name (Legal Business Name): GREAT PROFESSIONAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W 50TH ST STE 402
HIALEAH FL
33012-3440
US

IV. Provider business mailing address

1140 W 50TH ST STE 402
HIALEAH FL
33012-3440
US

V. Phone/Fax

Practice location:
  • Phone: 305-828-6528
  • Fax: 305-828-6529
Mailing address:
  • Phone: 305-828-6528
  • Fax: 305-828-6529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HUMBERTO MARTINEZ
Title or Position: PRESIDENT
Credential:
Phone: 305-828-6528