Healthcare Provider Details

I. General information

NPI: 1780230268
Provider Name (Legal Business Name): CENTRUM MEDICAL HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W 49TH ST STE 308
HIALEAH FL
33012-3435
US

IV. Provider business mailing address

9250 NW 36TH ST STE 420
DORAL FL
33178-2775
US

V. Phone/Fax

Practice location:
  • Phone: 305-266-2929
  • Fax:
Mailing address:
  • Phone: 305-266-2929
  • Fax: 305-579-6673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GRACIELA V VICTORERO
Title or Position: COO
Credential:
Phone: 305-266-2929