Healthcare Provider Details

I. General information

NPI: 1740721281
Provider Name (Legal Business Name): FLORIDA HEALTH CARE CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2017
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17986 FRANJO RD
PALMETTO BAY FL
33157
US

IV. Provider business mailing address

17986 FRANJO RD
PALMETTO BAY FL
33157-5641
US

V. Phone/Fax

Practice location:
  • Phone: 305-424-8351
  • Fax: 305-424-8352
Mailing address:
  • Phone: 305-424-8351
  • Fax: 305-424-8352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JORGE GONZALEZ
Title or Position: PRESIDENT
Credential:
Phone: 305-424-8351