Healthcare Provider Details

I. General information

NPI: 1437789872
Provider Name (Legal Business Name): PRIME CARE OF SOUTH DADE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14150 SW 119TH AVE
MIAMI FL
33186-6012
US

IV. Provider business mailing address

7765 NW 48TH ST STE 300
DORAL FL
33166-5404
US

V. Phone/Fax

Practice location:
  • Phone: 786-709-9362
  • Fax:
Mailing address:
  • Phone: 305-442-1740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAFAEL M GARCIA
Title or Position: MD
Credential: MD
Phone: 786-709-9362