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Organization
PROVIDENCE COMMUNITY CENTER LLC
Active
Organization
PROVIDENCE COMMUNITY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JULINA T DORVAL ARNP (MANAGING MEMBER)
(786) 546-5129
Entity
Organization
Contact information
Practice address
5932 NE 2ND AVE, MIAMI, FL 33137-2010
(786) 546-5129
(954) 241-6117
Mailing address
5932 NE 2ND AVE, MIAMI, FL 33137-2010
(786) 546-5129
(954) 241-6117
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME94972
FL
363LF0000X
Family Nurse Practitioner
Primary
3078052
FL
Other
Enumeration date
08/11/2014
Last updated
08/11/2014
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