Healthcare Provider Details

I. General information

NPI: 1255835419
Provider Name (Legal Business Name): PMR US HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 NW 167TH ST
MIAMI GARDENS FL
33169-5710
US

IV. Provider business mailing address

1395 NW 167TH ST
MIAMI GARDENS FL
33169-5710
US

V. Phone/Fax

Practice location:
  • Phone: 786-870-4039
  • Fax: 786-870-4039
Mailing address:
  • Phone: 786-870-4039
  • Fax: 786-870-4039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MARY CHEN
Title or Position: EXECUTIVE OFFICER
Credential:
Phone: 305-628-6117