Healthcare Provider Details

I. General information

NPI: 1558752964
Provider Name (Legal Business Name): MATTHEW PROMISE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2015
Last Update Date: 02/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

IV. Provider business mailing address

1850 SW 118TH AVE
MIRAMAR FL
33025-5627
US

V. Phone/Fax

Practice location:
  • Phone: 919-791-9873
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number299790
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: