Healthcare Provider Details

I. General information

NPI: 1780984377
Provider Name (Legal Business Name): C A MEDICAL SERVICE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 W 16TH AVE STE 248
HIALEAH FL
33012-4648
US

IV. Provider business mailing address

3750 W 16TH AVE STE 248
HIALEAH FL
33012-4648
US

V. Phone/Fax

Practice location:
  • Phone: 786-955-5546
  • Fax: 305-823-8821
Mailing address:
  • Phone: 786-955-5546
  • Fax: 305-823-8821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JORGE LUIS DIAZ
Title or Position: OWNER
Credential: LMT
Phone: 786-955-5546