Healthcare Provider Details

I. General information

NPI: 1790771236
Provider Name (Legal Business Name): PROFESSIONAL ORTHOPEDIC CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10329 NW 27TH AVE
MIAMI FL
33147-1224
US

IV. Provider business mailing address

10329 NW 27TH AVE
MIAMI FL
33147-1224
US

V. Phone/Fax

Practice location:
  • Phone: 305-696-3250
  • Fax: 305-696-3247
Mailing address:
  • Phone: 305-696-3250
  • Fax: 305-696-3247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number1964
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH23528
License Number StateFL

VIII. Authorized Official

Name: MS. MARISOL CEPERO SOSA
Title or Position: PRESIDENT
Credential:
Phone: 305-696-3250