Healthcare Provider Details

I. General information

NPI: 1235213737
Provider Name (Legal Business Name): PMN MEDICAL CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N.W. 57 AVE SUITE 200-240
MIAMI FL
33126
US

IV. Provider business mailing address

782 NW 42 AVE SUITE 550
MIAMI FL
33126
US

V. Phone/Fax

Practice location:
  • Phone: 305-265-0283
  • Fax: 305-675-2788
Mailing address:
  • Phone: 305-265-7066
  • Fax: 305-265-3466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME38850
License Number StateFL

VIII. Authorized Official

Name: MRS. MARTHA O HERNANDEZ
Title or Position: CREDENTIAL SPECIALIST
Credential:
Phone: 305-553-9669