| Ponce De Leon | |
|
5801 Augusto St Coral Gables FL 33146-2606 | |
| (305) 663-7425 | |
| Not Available |
| Full Name | Ponce De Leon |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 5801 Augusto St, Coral Gables, Florida |
| Authorized Official Name and Position | Brodes H Hartley (PRESIDENT/CEO) |
| Authorized Official Contact | 3052535100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ponce De Leon 10300 Sw 216th Street Miami FL 33190-1003 Ph: (305) 253-5100 | Ponce De Leon 5801 Augusto St Coral Gables FL 33146-2606 Ph: (305) 663-7425 |
| NPI Number | 1932522331 |
|---|---|
| Provider Enumeration Date | 01/22/2014 |
| Last Update Date | 01/22/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932522331 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | () | Primary |
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