Provider Demographics
NPI:1508882549
Name:PROFESSIONAL HEALTH CARE CENTER INC
Entity Type:Organization
Organization Name:PROFESSIONAL HEALTH CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YADENIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHIONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-403-0380
Mailing Address - Street 1:7821 CORAL WAY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6542
Mailing Address - Country:US
Mailing Address - Phone:305-403-0380
Mailing Address - Fax:305-403-0484
Practice Address - Street 1:7821 CORAL WAY
Practice Address - Street 2:SUITE 130
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6542
Practice Address - Country:US
Practice Address - Phone:305-403-0380
Practice Address - Fax:305-403-0484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8518207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9626Medicare ID - Type Unspecified