Healthcare Provider Details

I. General information

NPI: 1659008324
Provider Name (Legal Business Name): PRIMARY CARE EVERYWHERE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 SW 62ND ST
MIAMI FL
33143-1714
US

IV. Provider business mailing address

10033 SW 231ST LN
MIAMI FL
33190-1993
US

V. Phone/Fax

Practice location:
  • Phone: 305-216-2811
  • Fax:
Mailing address:
  • Phone: 305-216-2811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GIOVANNI MENA
Title or Position: MBR
Credential:
Phone: 305-216-2811