Healthcare Provider Details

I. General information

NPI: 1679495857
Provider Name (Legal Business Name): GRACE HEALING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4491 NW 36TH ST
MIAMI SPRINGS FL
33166-7226
US

IV. Provider business mailing address

4491 NW 36TH ST
MIAMI SPRINGS FL
33166-7226
US

V. Phone/Fax

Practice location:
  • Phone: 786-656-3323
  • Fax:
Mailing address:
  • Phone: 786-656-3323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JORGE E FERNANDEZ RAMIREZ
Title or Position: OWNER
Credential:
Phone: 786-656-3323