Healthcare Provider Details

I. General information

NPI: 1871204867
Provider Name (Legal Business Name): ARKIM PRIMARY CARE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1853 SE PORT ST LUCIE BLVD
PORT SAINT LUCIE FL
34952-5530
US

IV. Provider business mailing address

1853 SE PORT ST LUCIE BLVD
PORT SAINT LUCIE FL
34952-5530
US

V. Phone/Fax

Practice location:
  • Phone: 772-237-5244
  • Fax: 772-905-8047
Mailing address:
  • Phone: 772-237-5244
  • Fax: 772-905-8047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KALI GARCIA MALPICA
Title or Position: PRESIDENT
Credential: ARNP
Phone: 772-237-5244