Provider Demographics
NPI:1043676406
Name:PIERRE HEALTH CENTER AND MD SPA, INC
Entity Type:Organization
Organization Name:PIERRE HEALTH CENTER AND MD SPA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-717-5821
Mailing Address - Street 1:4980 W 10TH AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3437
Mailing Address - Country:US
Mailing Address - Phone:786-717-5821
Mailing Address - Fax:786-534-9306
Practice Address - Street 1:4980 W 10TH AVE STE 206
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3437
Practice Address - Country:US
Practice Address - Phone:786-717-5821
Practice Address - Fax:786-534-9306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service