Provider Demographics
NPI:1952055410
Name:CARDINAL PRIMARY CARE LLC
Entity Type:Organization
Organization Name:CARDINAL PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE MGER
Authorized Official - Prefix:
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-715-2505
Mailing Address - Street 1:11398 W FLAGLER ST STE 206
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1158
Mailing Address - Country:US
Mailing Address - Phone:786-715-2505
Mailing Address - Fax:966-671-1537
Practice Address - Street 1:11398 W FLAGLER ST STE 206
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1158
Practice Address - Country:US
Practice Address - Phone:786-715-2505
Practice Address - Fax:966-671-1537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center