| Premium Medical Center Corp | |
|
6405 Nw 36th St Ste 111 Virginia Gardens FL 33166-6977 | |
| (786) 334-5047 | |
| (786) 334-5048 |
| Full Name | Premium Medical Center Corp |
|---|---|
| Speciality | Clinic/center |
| Location | 6405 Nw 36th St Ste 111, Virginia Gardens, Florida |
| Authorized Official Name and Position | Mabel Gutierrez Concepcion (OWNER) |
| Authorized Official Contact | 7863345047 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Premium Medical Center Corp 6405 Nw 36th St Ste 111 Virginia Gardens FL 33166-6977 Ph: (786) 334-5047 | Premium Medical Center Corp 6405 Nw 36th St Ste 111 Virginia Gardens FL 33166-6977 Ph: (786) 334-5047 |
| NPI Number | 1053971937 |
|---|---|
| Provider Enumeration Date | 06/13/2019 |
| Last Update Date | 05/22/2020 |
| Certification Date | 05/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053971937 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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