1073201612 NPI number — SOUTH FLORIDA URGENT CARE CENTERS, LLC

Table of content: KATHERINE LAURA GUILLEN COTA (NPI 1417130741)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073201612 NPI number — SOUTH FLORIDA URGENT CARE CENTERS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH FLORIDA URGENT CARE CENTERS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073201612
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9117 SW 87TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33176-2302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-724-2434
Provider Business Mailing Address Fax Number:
305-846-9634

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9117 SW 87TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33176-2302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-724-2434
Provider Business Practice Location Address Fax Number:
305-846-9634
Provider Enumeration Date:
05/01/2023

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
JORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING DIRECTOR
Authorized Official Telephone Number:
56-060-3373

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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