MEDICARE: PALMETTO GENERAL HEALTH CARE 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	170100000X	Ph.D. Medical Genetics

General Provider Information

NPI Number	:	1801976451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO GENERAL HEALTH CARE INC.

Provider Business Mailing Address
First Line	:	4715 NW 157TH ST
Second Line	:	STE 124
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33014-6435
Country	:	US
Telephone Number	:	305-628-0102
Fax Number	:	305-628-0109

Provider Business Practice Location Address
First Line	:	4715 NW 157TH ST
Second Line	:	STE 124
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33014-6435
Country	:	US
Telephone Number	:	305-628-0102
Fax Number	:	305-628-0109

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	YUMIDA NARANJO
Credential	:
Telephone Number	:	786-301-7717

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	08/22/2020

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