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General NPI Number Information
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NPI Number | 1487088050
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Entity Type | Organization
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Legal Business Name | PREMIER VALUE FAMILY MEDICINE LLC
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Dates
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Enumeration Date | 08/30/2013
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 8352 SW 40 STREET
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City | MIAMI
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State | FL
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Zip | 33155-3354
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Country | US
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Telephone | 305-225-0707
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Fax | 888-208-1644
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Provider Business Mailing Address
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Address Line | 8352 SW 40 STREET
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City | MIAMI
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State | FL
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Zip | 33155-3354
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Country | US
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Telephone | 305-225-0707
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Fax | 888-208-1644
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Authorized Official
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Title or Position | PHYSICIAN/PRESIDENT
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Name | IDAYLIS MORONO-PONCE
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Credential | MD
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Telephone | 305-225-0707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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