Provider Demographics
NPI:1821103425
Name:WESTCHESTER PROFESSIONAL HEALTH SERVICES INC
Entity Type:Organization
Organization Name:WESTCHESTER PROFESSIONAL HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NUNEZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:305-269-4014
Mailing Address - Street 1:7171 SW 24 ST
Mailing Address - Street 2:SUITE 419
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155
Mailing Address - Country:US
Mailing Address - Phone:305-269-4014
Mailing Address - Fax:
Practice Address - Street 1:7171 SW 24 ST
Practice Address - Street 2:SUITE 419
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155
Practice Address - Country:US
Practice Address - Phone:305-269-4014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7187261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC7187OtherAHCA LICENSE