Healthcare Provider Details

I. General information

NPI: 1689958829
Provider Name (Legal Business Name): PREFERRED CARE PARTNERS MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2974 SW 8TH ST
MIAMI FL
33135-2827
US

IV. Provider business mailing address

PO BOX 566538
MIAMI FL
33256-6538
US

V. Phone/Fax

Practice location:
  • Phone: 305-631-3000
  • Fax: 305-631-3006
Mailing address:
  • Phone: 305-631-3000
  • Fax: 305-631-3006

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: MR. JOSEPH L CARUNCHO
Title or Position: PRESIDENT
Credential: ESQ.
Phone: 305-670-8440