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General NPI Number Information
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NPI Number | 1174995609
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE AND EDUCATIONAL CENTER OF MIAMI
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Dates
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Enumeration Date | 10/23/2015
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Last Update Date | 04/30/2024
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Provider Practice Location Address
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Address Line | 13205 SW 137TH AVE STE 232-233
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City | MIAMI
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State | FL
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Zip | 33186-5331
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Country | US
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Telephone | 786-290-9192
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Fax | 800-603-8893
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Provider Business Mailing Address
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Address Line | 13205 SW 137TH AVE # 224-225
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City | MIAMI
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State | FL
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Zip | 33186-5331
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Country | US
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Telephone | 786-290-9192
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Fax | 786-603-8893
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDDY MARCIAL
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Credential | ARNP
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Telephone | 786-290-9192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | ARNP9231287
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ARNP9231287
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License Number State | FL
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