Healthcare Provider Details

I. General information

NPI: 1588445753
Provider Name (Legal Business Name): PRIMARY CARE OF VENICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 E VENICE AVE STE 102B
VENICE FL
34285-9083
US

IV. Provider business mailing address

1370 E VENICE AVE STE 102B
VENICE FL
34285-9083
US

V. Phone/Fax

Practice location:
  • Phone: 77-248-9604
  • Fax:
Mailing address:
  • Phone: 727-300-0063
  • Fax: 727-954-6546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ZAID ALI
Title or Position: CEO
Credential:
Phone: 407-724-8960