Healthcare Provider Details

I. General information

NPI: 1477794089
Provider Name (Legal Business Name): NLC PLATINUM SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2009
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 W 16TH AVE # 5-244
HIALEAH FL
33012-7100
US

IV. Provider business mailing address

4410 W 16TH AVE # 5-244
HIALEAH FL
33012-7100
US

V. Phone/Fax

Practice location:
  • Phone: 305-910-7424
  • Fax:
Mailing address:
  • Phone: 305-910-7424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. NOEL LEAL CUBELA
Title or Position: PRESIDENT
Credential:
Phone: 305-910-7424