MEDICARE: PRIDE GROUP CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1003866609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIDE GROUP CENTER, INC.

Provider Business Mailing Address
First Line	:	692 W 29TH ST
Second Line	:	12
City	:	HIALEAH
State	:	FL
Zip	:	33012-5620
Country	:	US
Telephone Number	:	786-274-0386
Fax Number	:

Provider Business Practice Location Address
First Line	:	692 W 29TH ST
Second Line	:	12
City	:	HIALEAH
State	:	FL
Zip	:	33012-5620
Country	:	US
Telephone Number	:	786-274-0386
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. FELIPE CRUZ
Credential	:
Telephone Number	:	786-274-0386

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	08/22/2020

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Directions to “PRIDE GROUP CENTER, INC. ” Practice Location

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