Provider Demographics
NPI:1790730893
Name:PRO HEALTH MEDICAL CENTERS LLC
Entity Type:Organization
Organization Name:PRO HEALTH MEDICAL CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREL
Authorized Official - Middle Name:B
Authorized Official - Last Name:ARRECHEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-856-0884
Mailing Address - Street 1:1330 SW 22ND ST
Mailing Address - Street 2:SUITE 409
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2929
Mailing Address - Country:US
Mailing Address - Phone:305-856-0884
Mailing Address - Fax:305-856-0889
Practice Address - Street 1:1330 SW 22ND ST
Practice Address - Street 2:SUITE 409
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2929
Practice Address - Country:US
Practice Address - Phone:305-856-0884
Practice Address - Fax:305-856-0889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMM 15565OtherMASSAGE ESTABLISHMENT
FLHCC5775OtherHEALTH CARE CLINIC
K8699Medicare ID - Type UnspecifiedMEDICARE