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General NPI Number Information
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NPI Number | 1972261253
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Entity Type | Organization
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Legal Business Name | YOUR SUPREME HEALTH
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Dates
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Enumeration Date | 12/03/2021
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Last Update Date | 12/03/2021
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Provider Practice Location Address
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Address Line | 92 NE 49TH ST
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City | MIAMI
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State | FL
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Zip | 33137-3116
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Country | US
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Telephone | 786-439-6990
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Fax |
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Provider Business Mailing Address
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Address Line | 92 NE 49TH ST
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City | MIAMI
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State | FL
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Zip | 33137-3116
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MM
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Name | PAULINE HENRY
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Credential | FNP
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Telephone | 786-439-6990
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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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Taxonomy #2
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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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