Healthcare Provider Details

I. General information

NPI: 1285748285
Provider Name (Legal Business Name): SOUTH DADE PRIMARY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date: 04/26/2023
Reactivation Date: 05/10/2023

III. Provider practice location address

9835 E HIBISCUS ST
PALMETTO BAY FL
33157-5406
US

IV. Provider business mailing address

1000 NW 57TH CT STE 400
MIAMI FL
33126-3292
US

V. Phone/Fax

Practice location:
  • Phone: 305-238-8561
  • Fax:
Mailing address:
  • Phone: 786-485-1005
  • Fax: 786-441-2156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0027176
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0092409
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0016658
License Number StateFL

VIII. Authorized Official

Name: MARK L MULLINIX
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: AUTHORIZED OFFICIAL
Phone: 786-758-3135