Healthcare Provider Details

I. General information

NPI: 1962171207
Provider Name (Legal Business Name): MY PRECIOUS ANGEL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 NW SOUTH RIVER DR STE 113
MEDLEY FL
33166-7445
US

IV. Provider business mailing address

8600 NW SOUTH RIVER DR STE 113
MEDLEY FL
33166-7445
US

V. Phone/Fax

Practice location:
  • Phone: 786-556-5049
  • Fax:
Mailing address:
  • Phone: 786-556-5049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. NELSON HERNANDEZ
Title or Position: CEO
Credential:
Phone: 305-203-4936