PROVIDENCE COMMUNITY CENTER LLC NPI 1457760712

NPI Information

NPI: 1457760712
Provider Name: PROVIDENCE COMMUNITY CENTER LLC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

CLIA Number: 10D2095640

Address:
5932 NE 2ND AVE
MIAMI, FL
ZIP 33137
Phone: (786) 546-5129
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PROVIDENCE COMMUNITY CENTER LLC is a family nurse practitioner in Miami, FL. PROVIDENCE COMMUNITY CENTER LLC NPI is 1457760712. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

5932 NE 2ND AVE
MIAMI, FL
ZIP 33137-010
Phone: (786) 546-5129
Fax: (954) 241-6117

The provider's authorized official is Julina T Dorval .
The authorized official title is Managing Member and has the following contact phone number (786) 546-5129.

The CLIA number assigned to this NPI record is 10D2095640 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/11/2014 and was last updated on 8/11/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207R00000X	Internal Medicine		ME94972	FLORIDA	No
2	363LF0000X	Nurse Practitioner	Family	3078052	FLORIDA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	GN339	MEDICARE PIN	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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