Provider Demographics
NPI:1972580041
Name:QID PROFESSIONAL CARE INC
Entity type:Organization
Organization Name:QID PROFESSIONAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUNDORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-448-2399
Mailing Address - Street 1:4750 NW 7TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2253
Mailing Address - Country:US
Mailing Address - Phone:305-448-2399
Mailing Address - Fax:305-448-2392
Practice Address - Street 1:4750 NW 7TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2253
Practice Address - Country:US
Practice Address - Phone:305-448-2399
Practice Address - Fax:305-448-2392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL686786261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686786Medicare Oscar/Certification