Provider Demographics
NPI:1861648685
Name:PRUDENTIAL CARE GROUP, PA
Entity Type:Organization
Organization Name:PRUDENTIAL CARE GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA-SALADIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-858-6519
Mailing Address - Street 1:1394 CORAL WAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2960
Mailing Address - Country:US
Mailing Address - Phone:305-858-6519
Mailing Address - Fax:
Practice Address - Street 1:1394 CORAL WAY
Practice Address - Street 2:SUITE 3
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2960
Practice Address - Country:US
Practice Address - Phone:305-858-6519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty