Provider Demographics
NPI:1891317806
Name:SOCORRO HEALTH LLC
Entity Type:Organization
Organization Name:SOCORRO HEALTH LLC
Other - Org Name:SOCORRO HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CIOMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOCORRO
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:954-696-3093
Mailing Address - Street 1:10640 SW 20TH CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3963
Mailing Address - Country:US
Mailing Address - Phone:954-696-3093
Mailing Address - Fax:
Practice Address - Street 1:777 E 25TH ST STE 308
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3824
Practice Address - Country:US
Practice Address - Phone:954-696-3093
Practice Address - Fax:305-995-0947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-13
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty