Healthcare Provider Details

I. General information

NPI: 1164565685
Provider Name (Legal Business Name): MADRINA MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 NW 79TH AVE STE 430
DORAL FL
33166-6599
US

IV. Provider business mailing address

3900 NW 79TH AVE STE 430
DORAL FL
33166-6599
US

V. Phone/Fax

Practice location:
  • Phone: 786-235-7143
  • Fax:
Mailing address:
  • Phone: 786-235-7143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number7771
License Number StateFL

VIII. Authorized Official

Name: CARIDAD DOMINGUEZ
Title or Position: PRESIDENT
Credential:
Phone: 786-331-7769