Healthcare Provider Details

I. General information

NPI: 1639421928
Provider Name (Legal Business Name): FIRST CARE CLINIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9272 SW 40TH ST
MIAMI FL
33165-4151
US

IV. Provider business mailing address

9272 SW 40TH ST
MIAMI FL
33165-4151
US

V. Phone/Fax

Practice location:
  • Phone: 305-484-8969
  • Fax: 305-260-9678
Mailing address:
  • Phone: 305-484-8969
  • Fax: 305-260-9678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberME106369
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. BLANCA N GONZALEZ
Title or Position: CEO
Credential: MD
Phone: 305-484-8969