Healthcare Provider Details

I. General information

NPI: 1891333472
Provider Name (Legal Business Name): PRIMARY CARE MEDICAL CENTERS OF SOUTH FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2019
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 W 49TH ST STE 420
HIALEAH FL
33012-2978
US

IV. Provider business mailing address

1840 W 49TH ST STE 420
HIALEAH FL
33012-2978
US

V. Phone/Fax

Practice location:
  • Phone: 786-703-3085
  • Fax: 786-703-3086
Mailing address:
  • Phone: 786-375-0036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IRINA FONSECA
Title or Position: PRESIDENT
Credential:
Phone: 786-375-0036