Healthcare Provider Details

I. General information

NPI: 1053007054
Provider Name (Legal Business Name): MKCR HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 SW 153RD PL
MIAMI FL
33193-1310
US

IV. Provider business mailing address

8000 SW 153RD PL
MIAMI FL
33193-1310
US

V. Phone/Fax

Practice location:
  • Phone: 786-805-2418
  • Fax:
Mailing address:
  • Phone: 786-805-2418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ILIA GARCIA FERNANDEZ
Title or Position: OWNER
Credential:
Phone: 786-805-2418