Provider Demographics
NPI:1770794174
Name:PROFESSIONAL HEALTH CENTER CORP
Entity type:Organization
Organization Name:PROFESSIONAL HEALTH CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MANFOUD SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-385-3939
Mailing Address - Street 1:5600 SW 135TH AVE
Mailing Address - Street 2:STE 201 203
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-5182
Mailing Address - Country:US
Mailing Address - Phone:305-385-3939
Mailing Address - Fax:305-385-3466
Practice Address - Street 1:5600 SW 135TH AVE
Practice Address - Street 2:STE 201 203
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-5182
Practice Address - Country:US
Practice Address - Phone:305-385-3939
Practice Address - Fax:305-385-3466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5190207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty