Promed Healthcare Clinic LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

PROMED HEALTHCARE CLINIC LLC

Practice address

11400 W Flagler St Ste 202
Miami, FL 33174-4007

Phone

(305) 548-1118

Fax

(786) 558-5697

NPI assigned

Apr 23, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Magaly Pascal Travieso, ARNP

Title

Ceo

Phone

(786) 580-1859

Specialties & licenses 4

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1555977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727136000000",
    "number": "1285298521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11400 W FLAGLER ST STE 202",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331744007",
            "telephone_number": "305-548-1118",
            "fax_number": "786-558-5697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11400 W FLAGLER ST STE 202",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331744007",
            "telephone_number": "305-548-1118",
            "fax_number": "786-558-5697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMED HEALTHCARE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-23",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A",
        "authorized_official_last_name": "TRAVIESO",
        "authorized_official_first_name": "MAGALY",
        "authorized_official_middle_name": "PASCAL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "786-580-1859",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARNP9240892",
            "identifier": "T612540715810",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Miami, FL
• Providers in Miami, FL by specialty
• Community/Behavioral Health Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.