Healthcare Provider Details

I. General information

NPI: 1720349988
Provider Name (Legal Business Name): OMY MEDICAL CENTER, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 06/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 W 39TH PL STE 1001
HIALEAH FL
33012-7036
US

IV. Provider business mailing address

1750 W 39TH PL STE 1001
HIALEAH FL
33012-7036
US

V. Phone/Fax

Practice location:
  • Phone: 305-418-0916
  • Fax:
Mailing address:
  • Phone: 305-418-0916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. OMAR OJEDA SR.
Title or Position: PRESIDENT
Credential:
Phone: 305-418-0916