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General NPI Number Information
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NPI Number | 1770794174
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL HEALTH CENTER CORP
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5600 SW 135TH AVE STE 201 203
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City | MIAMI
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State | FL
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Zip | 33183-5182
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Country | US
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Telephone | 305-385-3939
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Fax | 305-385-3466
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Provider Business Mailing Address
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Address Line | 5600 SW 135TH AVE STE 201 203
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City | MIAMI
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State | FL
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Zip | 33183-5182
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Country | US
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Telephone | 305-385-3939
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Fax | 305-385-3466
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIA S MANFOUD SANCHEZ
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Credential |
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Telephone | 305-385-3939
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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 | HCC5190
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License Number State | FL
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