Provider Demographics
NPI:1275904344
Name:PEACE HEALTH INSTITUTE CORP
Entity Type:Organization
Organization Name:PEACE HEALTH INSTITUTE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-401-4728
Mailing Address - Street 1:6447 MIAMI LAKES DR E STE 222E
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2764
Mailing Address - Country:US
Mailing Address - Phone:305-401-4728
Mailing Address - Fax:305-402-0422
Practice Address - Street 1:6447 MIAMI LAKES DR E STE 222E
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2764
Practice Address - Country:US
Practice Address - Phone:305-401-4728
Practice Address - Fax:305-402-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-14
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty