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General NPI Number Information
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NPI Number | 1285298521
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Entity Type | Organization
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Legal Business Name | PROMED HEALTHCARE CLINIC LLC
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Dates
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Enumeration Date | 04/23/2019
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 11400 W FLAGLER ST STE 202
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City | MIAMI
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State | FL
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Zip | 33174-4007
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Country | US
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Telephone | 305-548-1118
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Fax | 786-558-5697
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Provider Business Mailing Address
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Address Line | 11400 W FLAGLER ST STE 202
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City | MIAMI
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State | FL
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Zip | 33174-4007
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Country | US
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Telephone | 305-548-1118
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Fax | 786-558-5697
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Authorized Official
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Title or Position | CEO
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Name | MRS. MAGALY PASCAL TRAVIESO
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Credential | ARNP
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Telephone | 786-580-1859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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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 | 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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