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NPI Code Detail

MEDICARE: PROMED HEALTHCARE CLINIC LLC

MEDICARE: PROMED HEALTHCARE CLINIC LLC
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
1171M00000XCase Manager/Care Coordinator
2261Q00000XClinic/Center
3363LF0000XFamily Nurse Practitioner
4251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1T612540715810OTHERFLARNP9240892

General Provider Information

NPI Number : 1285298521
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROMED HEALTHCARE CLINIC LLC
Provider Business Mailing Address
First Line : 11400 W FLAGLER ST STE 202
Second Line :
City : MIAMI
State : FL
Zip : 33174-4007
Country : US
Telephone Number : 305-548-1118
Fax Number : 786-558-5697
Provider Business Practice Location Address
First Line : 11400 W FLAGLER ST STE 202
Second Line :
City : MIAMI
State : FL
Zip : 33174-4007
Country : US
Telephone Number : 305-548-1118
Fax Number : 786-558-5697
Authorized Official
Title or Position : CEO
Name : MRS. MAGALY PASCAL TRAVIESO
Credential : ARNP
Telephone Number : 786-580-1859
Provider Enumeration Date : 04/23/2019
Last Update Date : 09/24/2024

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Directions to “PROMED HEALTHCARE CLINIC LLC ” Practice Location

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