MEDICARE: YADIRA 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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1750328878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YADIRA MEDICAL CENTER INC.

Provider Business Mailing Address
First Line	:	4315 NW 7TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3587
Country	:	US
Telephone Number	:	305-448-2986
Fax Number	:	305-448-2988

Provider Business Practice Location Address
First Line	:	4315 NW 7TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3587
Country	:	US
Telephone Number	:	305-448-2986
Fax Number	:	305-448-2988

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. GEOVANY MOYA
Credential	:
Telephone Number	:	305-448-2986

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	08/22/2020

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