Healthcare Provider Details

I. General information

NPI: 1558803056
Provider Name (Legal Business Name): CELEN MEDICAL GROUP, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 06/26/2022
Certification Date: 06/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7930 NW 36TH ST STE 215
DORAL FL
33166-6677
US

IV. Provider business mailing address

7930 NW 36TH ST STE 215
DORAL FL
33166-6677
US

V. Phone/Fax

Practice location:
  • Phone: 305-677-9110
  • Fax: 305-677-9111
Mailing address:
  • Phone: 305-677-9110
  • Fax: 877-347-5666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NOSLEN SANCHEZ MESA
Title or Position: PRESIDENT/CEO
Credential:
Phone: 305-587-2418