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General NPI Number Information
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NPI Number | 1053501874
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL CARE SERVICES
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Dates
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Enumeration Date | 07/27/2007
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Last Update Date | 07/27/2007
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Provider Practice Location Address
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Address Line | 865 E 10TH AVE
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City | HIALEAH
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State | FL
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Zip | 33010-4645
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Country | US
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Telephone | 305-885-5541
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Fax |
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Provider Business Mailing Address
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Address Line | 865 E 10TH AVE
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City | HIALEAH
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State | FL
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Zip | 33010-4645
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Country | US
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Telephone | 305-885-5541
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GUILLERMO JESUS OTERO
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Credential |
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Telephone | 305-885-5541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH7490
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License Number State | FL
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