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General NPI Number Information
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NPI Number | 1124840962
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Entity Type | Organization
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Legal Business Name | PROVENA CARE LLC
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Dates
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Enumeration Date | 10/31/2024
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 10251 SW 72ND ST STE 106
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City | MIAMI
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State | FL
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Zip | 33173-2957
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Country | US
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Telephone | 305-230-7371
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Fax | 305-428-3680
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Provider Business Mailing Address
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Address Line | 10251 SW 72ND ST STE 106
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City | MIAMI
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State | FL
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Zip | 33173-2957
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Country | US
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Telephone | 305-395-7108
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Fax | 305-428-3680
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | HECTOR FERNANDEZ
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Credential |
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Telephone | 305-230-7371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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