Healthcare Provider Details

I. General information

NPI: 1104790815
Provider Name (Legal Business Name): FIRST CLASS PRIMARY CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 TURNPIKE ST STE 33
CANTON MA
02021-2856
US

IV. Provider business mailing address

1017 TURNPIKE ST STE 33
CANTON MA
02021-2856
US

V. Phone/Fax

Practice location:
  • Phone: 781-236-7343
  • Fax:
Mailing address:
  • Phone: 781-236-7343
  • Fax:

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: YVEDA BRUTUS
Title or Position: OWNER
Credential: DNP
Phone: 781-236-7343