Healthcare Provider Details

I. General information

NPI: 1346409778
Provider Name (Legal Business Name): MIAMI PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9951 BIRD RD
MIAMI FL
33165-3989
US

IV. Provider business mailing address

9951 BIRD RD
MIAMI FL
33165-3989
US

V. Phone/Fax

Practice location:
  • Phone: 305-552-5350
  • Fax: 305-220-5602
Mailing address:
  • Phone: 305-552-5350
  • Fax: 305-220-5602

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 Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NELSON GARCIA MORALES
Title or Position: PRESIDENT
Credential: MD
Phone: 305-552-5350