Provider Demographics
NPI:1285358606
Name:MEDICA ONE HEALTH LLC
Entity type:Organization
Organization Name:MEDICA ONE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-589-5958
Mailing Address - Street 1:10794 PINES BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3920
Mailing Address - Country:US
Mailing Address - Phone:954-589-5958
Mailing Address - Fax:954-589-5785
Practice Address - Street 1:10794 PINES BLVD STE 202
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3920
Practice Address - Country:US
Practice Address - Phone:954-589-5958
Practice Address - Fax:954-589-5785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276279000Medicaid