Organization
PREMIUM MEDICAL CENTER CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEIVYS GONZALEZ OLIVA (AUTHORIZED OFFICIAL)
(786) 334-5047
Entity
Organization
Contact information
Practice address
6405 NW 36TH ST STE 111, VIRGINIA GARDENS, FL 33166-6977
(786) 334-5047
(786) 334-5048
Mailing address
6405 NW 36TH ST STE 111, VIRGINIA GARDENS, FL 33166-6977
(786) 334-5047
(786) 334-5048
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
06/13/2019
Last updated
01/14/2025
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