Healthcare Provider Details

I. General information

NPI: 1174390454
Provider Name (Legal Business Name): CORAZON DE JESUS MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4908 SW 8TH ST
CORAL GABLES FL
33134-2439
US

IV. Provider business mailing address

4908 SW 8TH ST
CORAL GABLES FL
33134-2439
US

V. Phone/Fax

Practice location:
  • Phone: 305-964-7749
  • Fax: 786-534-2917
Mailing address:
  • Phone: 305-964-7749
  • Fax: 786-534-2917

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 Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CARLOS ALBERTO DIAZ VALLADARES
Title or Position: OWNER
Credential: APRN
Phone: 786-488-4301