Healthcare Provider Details

I. General information

NPI: 1073227047
Provider Name (Legal Business Name): EL COMEDOR ADULT DAY CARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2023
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8003 NW 95TH ST UNIT 2
HIALEAH GARDENS FL
33016-2378
US

IV. Provider business mailing address

26 E 57TH ST
HIALEAH FL
33013-1234
US

V. Phone/Fax

Practice location:
  • Phone: 786-210-5484
  • Fax:
Mailing address:
  • Phone: 786-210-5484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SANDY GONZALEZ
Title or Position: OWNER
Credential:
Phone: 786-351-5273