Healthcare Provider Details

I. General information

NPI: 1164796157
Provider Name (Legal Business Name): PHYSICIANS COMPLETE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8260 W FLAGLER ST STE 2K
MIAMI FL
33144-2069
US

IV. Provider business mailing address

8260 W FLAGLER ST STE 2K
MIAMI FL
33144-2069
US

V. Phone/Fax

Practice location:
  • Phone: 305-456-3897
  • Fax:
Mailing address:
  • Phone: 305-456-3897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: LESTER PINO
Title or Position: PRESIDENT
Credential:
Phone: 305-456-3897