Provider Demographics
NPI:1821672056
Name:MIAMI PRIMARY HEALTHCARE
Entity Type:Organization
Organization Name:MIAMI PRIMARY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:VERGARA
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:786-722-0999
Mailing Address - Street 1:1275 W 47TH PL STE 307
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3447
Mailing Address - Country:US
Mailing Address - Phone:786-722-0999
Mailing Address - Fax:786-349-9000
Practice Address - Street 1:1275 W 47TH PL STE 307
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3447
Practice Address - Country:US
Practice Address - Phone:786-722-0999
Practice Address - Fax:786-349-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty