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General NPI Number Information
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NPI Number | 1104256528
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Entity Type | Organization
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Legal Business Name | PREMIUM HEALTH, INC.
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Dates
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Enumeration Date | 11/21/2013
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Last Update Date | 11/21/2013
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Provider Practice Location Address
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Address Line | 7235 CORAL WAY SUITE 205
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City | MIAMI
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State | FL
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Zip | 33155-1466
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Country | US
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Telephone | 305-265-1842
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Fax | 866-422-5780
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Provider Business Mailing Address
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Address Line | 7235 CORAL WAY SUITE 205
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City | MIAMI
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State | FL
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Zip | 33155-1466
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Country | US
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Telephone | 305-265-1842
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Fax | 866-422-5780
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. AMANDA ROCIO VEGA
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Credential | P.T
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Telephone | 305-265-1842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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