MEDICARE: SOUTHLAND CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1043693906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHLAND CLINIC

Provider Business Mailing Address
First Line	:	20920 S DIXIE HWY
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33189-2220
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20920 S DIXIE HWY
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33189-2220
Country	:	US
Telephone Number	:	305-222-5005
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	OSCILDA FERNANDEZ
Credential	:
Telephone Number	:	305-222-5005

Provider Enumeration Date	:	07/09/2015
Last Update Date	:	07/09/2015

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Directions to “SOUTHLAND CLINIC ” Practice Location

Language	Start Address	Practice Location

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