Healthcare Provider Details

I. General information

NPI: 1285838128
Provider Name (Legal Business Name): PCA TECH CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8483 S US HIGHWAY 1 STE 19
PORT ST LUCIE FL
34952-3360
US

IV. Provider business mailing address

8483 S US HIGHWAY 1 STE 19
PORT ST LUCIE FL
34952-3360
US

V. Phone/Fax

Practice location:
  • Phone: 772-873-1770
  • Fax: 772-873-1313
Mailing address:
  • Phone: 772-873-1770
  • Fax: 772-873-1313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. GENEVIEVE CARIDAD FERNANDEZ
Title or Position: CHIEF EXEC. OFFICER
Credential:
Phone: 772-873-1770