Provider Demographics
NPI:1033437454
Name:PRO-CARE MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:PRO-CARE MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:DARIO
Authorized Official - Last Name:DE LOS REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-262-7930
Mailing Address - Street 1:7480 SW 40TH ST
Mailing Address - Street 2:SUITE 740
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6600
Mailing Address - Country:US
Mailing Address - Phone:305-262-7930
Mailing Address - Fax:305-262-7932
Practice Address - Street 1:7480 SW 40TH ST
Practice Address - Street 2:SUITE 740
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6600
Practice Address - Country:US
Practice Address - Phone:305-262-7930
Practice Address - Fax:305-262-7932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center