Provider Demographics
NPI:1326374661
Name:PHYCARE NETWORK LLC
Entity Type:Organization
Organization Name:PHYCARE NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ISABELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-263-9883
Mailing Address - Street 1:PO BOX 441384
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-1384
Mailing Address - Country:US
Mailing Address - Phone:305-263-9883
Mailing Address - Fax:305-269-8825
Practice Address - Street 1:7805 CORAL WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6539
Practice Address - Country:US
Practice Address - Phone:305-263-9883
Practice Address - Fax:305-269-8825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty