Provider Demographics
NPI:1912262791
Name:PREVENTIVE HEALTH INC
Entity type:Organization
Organization Name:PREVENTIVE HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:LORENZO
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-819-1110
Mailing Address - Street 1:8040 NW 95TH ST
Mailing Address - Street 2:SUITE 331-332
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2362
Mailing Address - Country:US
Mailing Address - Phone:305-819-1110
Mailing Address - Fax:
Practice Address - Street 1:8040 NW 95TH ST
Practice Address - Street 2:SUITE 331-332
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016-2362
Practice Address - Country:US
Practice Address - Phone:305-819-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106903207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty