Healthcare Provider Details

I. General information

NPI: 1780860668
Provider Name (Legal Business Name): MEDCHOICE OF WEST HIALEAH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 W 46TH ST SUITE 8
HIALEAH FL
33012-3283
US

IV. Provider business mailing address

PO BOX 141799
CORAL GABLES FL
33144-1799
US

V. Phone/Fax

Practice location:
  • Phone: 305-828-0048
  • Fax: 305-828-2639
Mailing address:
  • Phone: 305-828-0048
  • Fax: 305-828-2639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: MARIA DIAZ
Title or Position: PRESIDENT
Credential: DO
Phone: 305-828-0048