Healthcare Provider Details

I. General information

NPI: 1376422113
Provider Name (Legal Business Name): PATRICK MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6882 W FLAGLER ST
MIAMI FL
33144-2814
US

IV. Provider business mailing address

15585 SW 112TH WAY
MIAMI FL
33196-5301
US

V. Phone/Fax

Practice location:
  • Phone: 786-350-6080
  • Fax:
Mailing address:
  • Phone: 786-350-6080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA T ROQUE PEREIRA
Title or Position: PRESIDENT
Credential:
Phone: 786-716-0059