Healthcare Provider Details

I. General information

NPI: 1750418299
Provider Name (Legal Business Name): PRIMARY CARE MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 STIRLING RD SUITE 3
HOLLYWOOD FL
33024-8067
US

IV. Provider business mailing address

PO BOX 848127
PEMBROKE PINES FL
33084-0127
US

V. Phone/Fax

Practice location:
  • Phone: 954-517-9166
  • Fax: 954-517-9167
Mailing address:
  • Phone: 954-517-9166
  • Fax: 954-517-9167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME79139
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME69293
License Number StateFL

VIII. Authorized Official

Name: DR. MARIE-ALICE LARA
Title or Position: VICE PRESIDENTD
Credential: MD
Phone: 954-517-9166