Organization
PRIMARY MEDICAL CARE CENTER IV, INC.
Active
Other names
Primary Medical Care Center IV, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
PRINSTON JEAN-GLUADE (CEO)
(305) 345-1369
Entity
Organization
Contact information
Practice address
1233 45TH ST STE B4, MANGONIA PARK, FL 33407-2162
(561) 250-0000
(888) 365-3056
Mailing address
11500 NW 7TH AVE, MIAMI, FL 33168-2506
(561) 250-0000
(888) 365-3056
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
261Q00000X
Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
01/04/2023
Last updated
01/04/2023
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