Healthcare Provider Details

I. General information

NPI: 1861738197
Provider Name (Legal Business Name): L.S.L MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 W FLAGLER ST
CORAL GABLES FL
33134-1513
US

IV. Provider business mailing address

7175 SW 8TH ST STE 213
MIAMI FL
33144-4674
US

V. Phone/Fax

Practice location:
  • Phone: 305-443-8229
  • Fax: 305-443-8230
Mailing address:
  • Phone: 305-443-8229
  • Fax: 305-443-8230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberHCC8617
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. OSMEL MARTINEZ
Title or Position: VP
Credential:
Phone: 305-443-8229