Healthcare Provider Details

I. General information

NPI: 1972580041
Provider Name (Legal Business Name): QID PROFESSIONAL CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 NW 7TH ST SUITE 2
MIAMI FL
33126-2253
US

IV. Provider business mailing address

4750 NW 7TH ST SUITE 2
MIAMI FL
33126-2253
US

V. Phone/Fax

Practice location:
  • Phone: 305-448-2399
  • Fax: 305-448-2392
Mailing address:
  • Phone: 305-448-2399
  • Fax: 305-448-2392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number686786
License Number StateFL

VIII. Authorized Official

Name: DANIELA FUNDORA
Title or Position: ADMINISTRATOR
Credential:
Phone: 305-448-2399