MEDICARE: DELUX MEDICAL CENTER INC

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	174400000X	Specialist
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1386031722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELUX MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	3750 W 16TH AVE STE 118
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4645
Country	:	US
Telephone Number	:	786-320-1245
Fax Number	:	786-332-4109

Provider Business Practice Location Address
First Line	:	3750 W 16TH AVE STE 118
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4645
Country	:	US
Telephone Number	:	786-320-1245
Fax Number	:	786-332-4109

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALBERTO PEREZ
Credential	:
Telephone Number	:	786-332-4009

Provider Enumeration Date	:	04/23/2015
Last Update Date	:	04/23/2015

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