Healthcare Provider Details

I. General information

NPI: 1730750514
Provider Name (Legal Business Name): FAMILY QUALITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5881 NW 151ST ST STE 211
MIAMI LAKES FL
33014-2456
US

IV. Provider business mailing address

5881 NW 151ST ST STE 211
MIAMI LAKES FL
33014-2456
US

V. Phone/Fax

Practice location:
  • Phone: 786-360-4353
  • Fax:
Mailing address:
  • Phone: 786-360-4353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSE HERNANDEZ
Title or Position: OWNER
Credential:
Phone: 786-360-4353