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General NPI Number Information
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NPI Number | 1245278266
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL SOLUTION GRP INC
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3250 W 16TH AVE NO. 208
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City | HIALEAH
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State | FL
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Zip | 33012-4606
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Country | US
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Telephone | 786-308-8065
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Fax |
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Provider Business Mailing Address
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Address Line | 3250 W 16TH AVE NO. 208
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City | HIALEAH
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State | FL
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Zip | 33012-4606
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Country | US
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Telephone | 786-308-8065
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. GLADYS GOMEZ
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Credential |
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Telephone | 786-308-8065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | FL
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