Healthcare Provider Details

I. General information

NPI: 1629609326
Provider Name (Legal Business Name): BOISE MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2020
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7715 NW 48TH ST STE 350
DORAL FL
33166-5473
US

IV. Provider business mailing address

7715 NW 48TH ST STE 350
DORAL FL
33166-5473
US

V. Phone/Fax

Practice location:
  • Phone: 786-536-7268
  • Fax: 786-536-7608
Mailing address:
  • Phone: 786-536-7268
  • Fax: 786-536-7608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: CESAR J DIAZ HERNANDEZ
Title or Position: OWNER
Credential:
Phone: 786-536-7268