Provider Demographics
NPI:1760190763
Name:PRINCIPLE CARE CENTER INC
Entity Type:Organization
Organization Name:PRINCIPLE CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIRTA
Authorized Official - Middle Name:
Authorized Official - Last Name:PLASENCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-334-5663
Mailing Address - Street 1:4445 W 16TH AVE STE 602
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2960
Mailing Address - Country:US
Mailing Address - Phone:786-334-5663
Mailing Address - Fax:
Practice Address - Street 1:4445 W 16TH AVE STE 602
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2960
Practice Address - Country:US
Practice Address - Phone:786-334-5663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-08
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty