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General NPI Number Information
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NPI Number | 1306340294
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Entity Type | Organization
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Legal Business Name | ORIGINAL HEALTHCARE CORP
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Dates
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Enumeration Date | 03/23/2018
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Last Update Date | 03/23/2018
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Provider Practice Location Address
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Address Line | 11981 SW 144TH CT STE 101
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City | MIAMI
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State | FL
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Zip | 33186-8652
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Country | US
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Telephone | 786-485-3881
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Fax | 305-675-0219
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Provider Business Mailing Address
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Address Line | 11981 SW 144TH CT STE 101
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City | MIAMI
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State | FL
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Zip | 33186-8652
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Country | US
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Telephone | 786-485-3881
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Fax | 305-675-0219
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAIDY GUTIERREZ
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Credential |
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Telephone | 786-485-3881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | HCC11288
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License Number State | FL
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