Healthcare Provider Details

I. General information

NPI: 1427283001
Provider Name (Legal Business Name): VENUS MEDICAL CENTER, CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 W 20TH AVE STE 305
HIALEAH FL
33016
US

IV. Provider business mailing address

7100 W 20TH AVE STE 305
HIALEAH FL
33016-1811
US

V. Phone/Fax

Practice location:
  • Phone: 305-824-1924
  • Fax: 305-824-1925
Mailing address:
  • Phone: 305-824-1924
  • Fax: 305-824-1925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUAN C GUTIERREZ
Title or Position: PRESIDENT
Credential:
Phone: 305-824-1924