Provider Demographics
NPI:1710434485
Name:PRIMECARE FAMILY CENTERS CORP
Entity Type:Organization
Organization Name:PRIMECARE FAMILY CENTERS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NERELYS
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-442-2228
Mailing Address - Street 1:1914 NW 84TH AVE
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1030
Mailing Address - Country:US
Mailing Address - Phone:305-442-2228
Mailing Address - Fax:305-442-2207
Practice Address - Street 1:4131 SW 6TH ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2057
Practice Address - Country:US
Practice Address - Phone:305-442-2228
Practice Address - Fax:305-442-2207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-09
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45472207Q00000X
FLME43821208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty