Healthcare Provider Details

I. General information

NPI: 1508882549
Provider Name (Legal Business Name): PROFESSIONAL HEALTH CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7821 CORAL WAY SUITE 130
MIAMI FL
33155-6542
US

IV. Provider business mailing address

7821 CORAL WAY SUITE 130
MIAMI FL
33155-6542
US

V. Phone/Fax

Practice location:
  • Phone: 305-403-0380
  • Fax: 305-403-0484
Mailing address:
  • Phone: 305-403-0380
  • Fax: 305-403-0484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberOS8518
License Number StateFL

VIII. Authorized Official

Name: MRS. YADENIS ACHIONG
Title or Position: OFFICE MANAGER
Credential:
Phone: 305-403-0380