# PROVIDER ASSOCIATES IPA

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124713045
- **Authorized official:** MR. LUIS DE LAMAR (CEO)
- **Authorized official phone:** (305) 606-6494

## Contact information

- **Practice address:** 25865 SW 139TH PATH, HOMESTEAD, FL 33032-6696
- **Practice address phone:** (305) 606-6494
- **Mailing address:** 25865 SW 139TH PATH, HOMESTEAD, FL 33032-6696
- **Mailing address phone:** (305) 606-6494

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | — | NULL | Yes |

## Other

- **Enumeration date:** 04/06/2023
- **Last updated:** 04/06/2023