Healthcare Provider Details

I. General information

NPI: 1659750867
Provider Name (Legal Business Name): CENTRO MEDICO INTEGRATIVO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROYAL RECIDENCE, FRENTE BANCO POPULAR
CABARETE DOMINICAN REPUBLIC
00000
DO

IV. Provider business mailing address

8260 NW 14TH STREET D-3216
DORAL FL
33126
US

V. Phone/Fax

Practice location:
  • Phone: 809-571-9520
  • Fax:
Mailing address:
  • Phone: 407-931-1717
  • Fax: 407-429-3834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

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