Provider Demographics
NPI:1821328048
Name:PROACTIVE MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:PROACTIVE MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:LUCIA
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-223-5369
Mailing Address - Street 1:1951 SW 172ND AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5593
Mailing Address - Country:US
Mailing Address - Phone:786-223-5669
Mailing Address - Fax:
Practice Address - Street 1:1951 SW 172ND AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5593
Practice Address - Country:US
Practice Address - Phone:786-223-5669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty