MEDICARE: INDAGO RESEARCH AND HEALTH 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	261QR1100X	Research Clinic/Center	0430020000130	FL

General Provider Information

NPI Number	:	1699011122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDAGO RESEARCH AND HEALTH CENTER, INC

Provider Business Mailing Address
First Line	:	3700 W 12TH AVE STE 300
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4170
Country	:	US
Telephone Number	:	305-827-3335
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 W 12TH AVE STE 300
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4170
Country	:	US
Telephone Number	:	305-827-3335
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. MARIA V PEREZ
Credential	:
Telephone Number	:	305-827-3335

Provider Enumeration Date	:	01/03/2013
Last Update Date	:	08/05/2015

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