=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336762889
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FERRER PRIMARY CARE INSTITUTE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2020
-----------------------------------------------------
Last Update Date | 09/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 N FEDERAL HWY # 601
-----------------------------------------------------
City | HALLANDALE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33009-2449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-482-4747
-----------------------------------------------------
Fax | 954-301-5939
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 701 N FEDERAL HWY # 601
-----------------------------------------------------
City | HALLANDALE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33009-2449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-482-4747
-----------------------------------------------------
Fax | 954-301-5939
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | CINTHYA ROQUE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-482-4747
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------