Provider Demographics
NPI:1255949012
Name:PHYSICIAN HEALTH CENTER CORP
Entity type:Organization
Organization Name:PHYSICIAN HEALTH CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-283-6254
Mailing Address - Street 1:1150 NW 72ND AVE STE 450
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1947
Mailing Address - Country:US
Mailing Address - Phone:305-283-6254
Mailing Address - Fax:
Practice Address - Street 1:1150 NW 72ND AVE STE 450
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-1947
Practice Address - Country:US
Practice Address - Phone:305-283-6254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health