Provider Demographics
NPI:1962995845
Name:PRIMARY CARE SPECIALIST OF SOUTH FLORIDA PA
Entity type:Organization
Organization Name:PRIMARY CARE SPECIALIST OF SOUTH FLORIDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARYNET
Authorized Official - Middle Name:
Authorized Official - Last Name:BELTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:954-937-4828
Mailing Address - Street 1:20200 W DIXIE HIGH WAY
Mailing Address - Street 2:1105A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33301
Mailing Address - Country:US
Mailing Address - Phone:786-275-3727
Mailing Address - Fax:305-599-4119
Practice Address - Street 1:4850 W OAKLAND PARK BLVD STE 143
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-7277
Practice Address - Country:US
Practice Address - Phone:786-275-3725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-14
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty