Healthcare Provider Details

I. General information

NPI: 1982855359
Provider Name (Legal Business Name): DEL PRADO MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 DEL PRADO BLVD S
CAPE CORAL FL
33904-5750
US

IV. Provider business mailing address

2500 DEL PRADO BLVD S
CAPE CORAL FL
33904-5750
US

V. Phone/Fax

Practice location:
  • Phone: 239-772-1194
  • Fax: 239-772-1196
Mailing address:
  • Phone: 239-772-1194
  • Fax: 239-772-1196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAISY MARTINEZ
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 239-772-1194