Healthcare Provider Details

I. General information

NPI: 1750827531
Provider Name (Legal Business Name): PROFESSIONALS CARING FOR HUMANITY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9421 S ORANGE BLOSSOM TRL # 19
ORLANDO FL
32837-8320
US

IV. Provider business mailing address

10 NW 42ND AVE STE 220
MIAMI FL
33126-5475
US

V. Phone/Fax

Practice location:
  • Phone: 407-601-2527
  • Fax: 407-674-6640
Mailing address:
  • Phone: 305-644-4410
  • Fax: 305-644-0114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LARRY DE JESUS
Title or Position: DCP
Credential: ADMINISTRATOR
Phone: 305-644-4410