Healthcare Provider Details

I. General information

NPI: 1700822749
Provider Name (Legal Business Name): L C MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 W 12TH AVE
HIALEAH FL
33014-5154
US

IV. Provider business mailing address

13875 SW 20TH ST
MIAMI FL
33175-7514
US

V. Phone/Fax

Practice location:
  • Phone: 305-362-6868
  • Fax: 305-362-6870
Mailing address:
  • Phone: 305-244-2546
  • Fax: 305-368-6870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberME 92214
License Number StateFL

VIII. Authorized Official

Name: DR. ISMAEL LABRADOR
Title or Position: PRESIDENT
Credential: MD
Phone: 305-244-2546