| Primary Physician Resource, LLC | |
|
330 Sw 27th Ave Ste 403b Miami FL 33135-2967 | |
| (786) 348-2589 | |
| Not Available |
| Full Name | Primary Physician Resource, LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 330 Sw 27th Ave Ste 403b, Miami, Florida |
| Authorized Official Name and Position | Kristiane Villalvazo-gonzalez (MANAGING MEMBER) |
| Authorized Official Contact | 7863482589 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Physician Resource, LLC Po Box 430764 Miami FL 33243-0764 | Primary Physician Resource, LLC 330 Sw 27th Ave Ste 403b Miami FL 33135-2967 Ph: (786) 348-2589 |
| NPI Number | 1003504531 |
|---|---|
| Provider Enumeration Date | 04/24/2023 |
| Last Update Date | 04/25/2023 |
| Certification Date | 04/25/2023 |
| Medicare PECOS PAC ID | 8921466889 |
|---|---|
| Medicare Enrollment ID | O20230626000004 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003504531 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
| Provider Name | Melkis Martinez Casas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487405692 PECOS PAC ID: 8224559398 Enrollment ID: I20250305001672 |
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