Healthcare Provider Details

I. General information

NPI: 1992594766
Provider Name (Legal Business Name): HOLLY MEDICAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11880 SW 40TH ST STE 402
MIAMI FL
33175-3575
US

IV. Provider business mailing address

11880 SW 40TH ST STE 402
MIAMI FL
33175-3575
US

V. Phone/Fax

Practice location:
  • Phone: 305-985-8559
  • Fax:
Mailing address:
  • Phone: 305-985-8559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ERIK SUAREZ SOLIS
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential:
Phone: 305-985-8559