Healthcare Provider Details

I. General information

NPI: 1144192386
Provider Name (Legal Business Name): PREMIUM HEALTHCARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9260 SW 72ND ST STE 207
MIAMI FL
33173-3255
US

IV. Provider business mailing address

9260 SW 72ND ST STE 207
MIAMI FL
33173-3255
US

V. Phone/Fax

Practice location:
  • Phone: 786-238-7057
  • Fax: 786-803-8859
Mailing address:
  • Phone: 786-238-7057
  • Fax: 786-803-8859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IVELICE LOZANO OLIVER
Title or Position: OWNER
Credential:
Phone: 786-961-1592