Provider Demographics
NPI:1205179199
Name:GREAT PROFESSIONAL CENTER INC
Entity Type:Organization
Organization Name:GREAT PROFESSIONAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:HUMBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:305-828-6528
Mailing Address - Street 1:1140 W 50TH ST STE 402
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3439
Mailing Address - Country:US
Mailing Address - Phone:305-828-6528
Mailing Address - Fax:305-828-6529
Practice Address - Street 1:1140 W 50TH ST STE 402
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3439
Practice Address - Country:US
Practice Address - Phone:305-828-6528
Practice Address - Fax:305-828-6529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC10489261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service