Healthcare Provider Details

I. General information

NPI: 1801338009
Provider Name (Legal Business Name): DY MEDICAL CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2016
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 E 9TH ST
HIALEAH FL
33010-4553
US

IV. Provider business mailing address

731 E 9TH ST
HIALEAH FL
33010-4553
US

V. Phone/Fax

Practice location:
  • Phone: 305-863-2067
  • Fax: 305-803-2027
Mailing address:
  • Phone: 305-863-2067
  • Fax: 305-803-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DYANET GALLO
Title or Position: PRESIDENT
Credential:
Phone: 305-863-2067