Healthcare Provider Details

I. General information

NPI: 1740045236
Provider Name (Legal Business Name): UNIVERSAL HEALTH COMMUNITY SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8551 NW SOUTH RIVER DR
MEDLEY FL
33166-7426
US

IV. Provider business mailing address

8551 NW SOUTH RIVER DR
MEDLEY FL
33166-7426
US

V. Phone/Fax

Practice location:
  • Phone: 305-603-9344
  • Fax: 305-631-2180
Mailing address:
  • Phone: 305-603-9344
  • Fax: 305-631-2180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JAIRO ALFONSO VILLAMIZAR PARDO
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 786-961-8512