Healthcare Provider Details

I. General information

NPI: 1558505297
Provider Name (Legal Business Name): PHYSICIANS CARE GROUP HEALTH CHOICE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 PALM AVE STE C
HIALEAH FL
33012-4424
US

IV. Provider business mailing address

4201 PALM AVE STE C
HIALEAH FL
33012-4424
US

V. Phone/Fax

Practice location:
  • Phone: 305-796-3544
  • Fax: 305-823-0096
Mailing address:
  • Phone: 305-796-3544
  • Fax: 305-823-0096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number StateFL

VIII. Authorized Official

Name: ENRIQUE ZAMORA
Title or Position: PRESIDENT
Credential:
Phone: 305-796-3544