Healthcare Provider Details

I. General information

NPI: 1538952973
Provider Name (Legal Business Name): NINOJESUS MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 W 20TH AVE STE 101
HIALEAH FL
33016-1895
US

IV. Provider business mailing address

16400 SW 173RD AVE
MIAMI FL
33187-1251
US

V. Phone/Fax

Practice location:
  • Phone: 305-456-4096
  • Fax: 786-828-7995
Mailing address:
  • Phone: 305-456-4096
  • Fax: 786-828-7995

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 Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CARLOS DIAZ VALLADARES
Title or Position: OWNER
Credential: APRN
Phone: 305-456-4096