Provider Demographics
NPI:1407596810
Name:PROFESSIONAL MEDICAL RESEARCH LLC
Entity Type:Organization
Organization Name:PROFESSIONAL MEDICAL RESEARCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ARIADNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-251-3454
Mailing Address - Street 1:6960 TAFT ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3802
Mailing Address - Country:US
Mailing Address - Phone:954-251-3454
Mailing Address - Fax:954-251-3474
Practice Address - Street 1:6960 TAFT ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-3802
Practice Address - Country:US
Practice Address - Phone:954-251-3454
Practice Address - Fax:954-251-3474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-01
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center