Provider Demographics
NPI:1487794731
Name:TOTAL FAMILY CARE CENTER IV INC
Entity type:Organization
Organization Name:TOTAL FAMILY CARE CENTER IV INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-246-0460
Mailing Address - Street 1:38 NW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4405
Mailing Address - Country:US
Mailing Address - Phone:305-246-0460
Mailing Address - Fax:305-246-0516
Practice Address - Street 1:38 NW 8TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4405
Practice Address - Country:US
Practice Address - Phone:305-246-0460
Practice Address - Fax:305-246-0516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0000703261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center