Healthcare Provider Details

I. General information

NPI: 1184193138
Provider Name (Legal Business Name): PDL VIRTUAL URGENT CARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7167 W FLAGLER ST
MIAMI FL
33144-2601
US

IV. Provider business mailing address

7167 W FLAGLER ST
MIAMI FL
33144-2601
US

V. Phone/Fax

Practice location:
  • Phone: 305-266-3705
  • Fax: 305-266-3706
Mailing address:
  • Phone: 305-266-3705
  • Fax: 305-266-3706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. YORDY JULIAN PONCE DE LEON
Title or Position: PRESIDENT
Credential: PHARM D
Phone: 305-266-3705