Healthcare Provider Details

I. General information

NPI: 1831421817
Provider Name (Legal Business Name): VRC GROUP SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13876 SW 56TH ST SUITE 277
MIAMI FL
33175-6021
US

IV. Provider business mailing address

13876 SW 56TH ST SUITE 277
MIAMI FL
33175-6021
US

V. Phone/Fax

Practice location:
  • Phone: 786-356-6023
  • Fax: 305-402-2323
Mailing address:
  • Phone: 786-356-6023
  • Fax: 305-402-2323

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
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MARTHA AMADOR DIAZ
Title or Position: PRESIDENT
Credential:
Phone: 786-356-6023