Healthcare Provider Details

I. General information

NPI: 1730402801
Provider Name (Legal Business Name): UNIVERSAL MEDICAL CENTER OF FLORIDA CITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 W PALM DR
FLORIDA CITY FL
33034-3223
US

IV. Provider business mailing address

751 W PALM DR
FLORIDA CITY FL
33034-3223
US

V. Phone/Fax

Practice location:
  • Phone: 786-377-0120
  • Fax: 786-237-3771
Mailing address:
  • Phone: 786-377-0120
  • Fax: 786-237-3771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. OCTAVIO BRAVO
Title or Position: MANAGING MEMBER
Credential: R.N.
Phone: 786-422-6525