Provider Demographics
NPI:1679891063
Name:PRIMARY AND SPECIALTY CARE, LLC
Entity type:Organization
Organization Name:PRIMARY AND SPECIALTY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-637-1453
Mailing Address - Street 1:13350 JOG ROAD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446
Mailing Address - Country:US
Mailing Address - Phone:561-637-1453
Mailing Address - Fax:561-637-1457
Practice Address - Street 1:13350 JOG ROAD
Practice Address - Street 2:SUITE 204
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446
Practice Address - Country:US
Practice Address - Phone:561-637-1453
Practice Address - Fax:561-637-1457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67047174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty