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General NPI Number Information
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NPI Number | 1386929636
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Entity Type | Organization
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Legal Business Name | PRIMERA URGENT PRIMARY CARE CENTER, LLC
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | 3861 AVALON PARK EAST BLVD
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City | ORLANDO
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State | FL
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Zip | 32828-4853
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Country | US
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Telephone | 914-525-6527
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 805
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City | YONKERS
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State | NY
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Zip | 10704-0805
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Country | US
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Telephone | 914-525-6527
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, CEO
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Name | RALPH FLEURANTIN
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Credential |
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Telephone | 914-525-6527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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