MEDICARE: ERICK UNLIMITED II 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
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1528819455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERICK UNLIMITED II LLC

Provider Business Mailing Address
First Line	:	4526 PALM AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4034
Country	:	US
Telephone Number	:	786-600-7560
Fax Number	:

Provider Business Practice Location Address
First Line	:	4526 PALM AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4034
Country	:	US
Telephone Number	:	786-600-7560
Fax Number	:	786-643-5503

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ERICK CASTRO
Credential	:
Telephone Number	:	786-447-2391

Provider Enumeration Date	:	03/28/2024
Last Update Date	:	03/28/2024

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