Healthcare Provider Details

I. General information

NPI: 1629652995
Provider Name (Legal Business Name): MD ACCESS MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5511 S CONGRESS AVE STE 101
ATLANTIS FL
33462-1140
US

IV. Provider business mailing address

22031 SW 127TH AVE
MIAMI FL
33170-2603
US

V. Phone/Fax

Practice location:
  • Phone: 786-256-7736
  • Fax:
Mailing address:
  • Phone: 786-256-7736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. OSVALDO A LOPEZ
Title or Position: CEO
Credential: ARNP
Phone: 786-256-7736