Healthcare Provider Details

I. General information

NPI: 1073147260
Provider Name (Legal Business Name): VENECIA MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5890 W 20TH AVE
HIALEAH FL
33016-2656
US

IV. Provider business mailing address

6300 CORPORATE CT
FORT MYERS FL
33919-3513
US

V. Phone/Fax

Practice location:
  • Phone: 239-202-8998
  • Fax: 239-471-0454
Mailing address:
  • Phone: 772-237-0712
  • Fax: 239-471-0454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. CLAUDIA DEL PINO
Title or Position: MANAGER
Credential:
Phone: 786-326-2667