Healthcare Provider Details

I. General information

NPI: 1336419050
Provider Name (Legal Business Name): CENTRO MEDICO BOURNIGAL, S.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE ANTERA MOTA S/N APARTADO POSTAL NO.25
PUERTO PLATA DOMINCAN REPUBLIC
NONE
DO

IV. Provider business mailing address

BM: 0300095, 8400 NW 25TH STREET
DORAL FL
33122
US

V. Phone/Fax

Practice location:
  • Phone: 809-586-2342
  • Fax:
Mailing address:
  • Phone: 407-931-1717
  • Fax: 407-931-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. ALBERTO A MENA
Title or Position: BILLING DIRECTOR
Credential:
Phone: 407-931-1717