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General NPI Number Information
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NPI Number | 1497073720
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Entity Type | Organization
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Legal Business Name | PREMIUM QUALITY MEDICAL CENTER, CORP.
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Dates
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Enumeration Date | 05/11/2010
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Last Update Date | 05/11/2010
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Provider Practice Location Address
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Address Line | 8080 W FLAGLER ST STE 3A
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City | MIAMI
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State | FL
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Zip | 33144-2100
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Country | US
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Telephone | 305-266-6531
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Fax | 305-266-6533
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Provider Business Mailing Address
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Address Line | 8080 W FLAGLER ST STE 3A
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City | MIAMI
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State | FL
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Zip | 33144-2100
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Country | US
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Telephone | 305-266-6531
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Fax | 305-266-6533
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Authorized Official
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Title or Position | PRESIDENT
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Name | ULISES PUENTES
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Credential |
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Telephone | 786-718-0122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | HCC8671
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License Number State | FL
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