Healthcare Provider Details

I. General information

NPI: 1881851426
Provider Name (Legal Business Name): LITTLE HAVANA ACTIVITIES AND NUTRITION CENTERS OF DADE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 07/19/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 W 16TH AVE SUITE #28C
HIALEAH FL
33012-7100
US

IV. Provider business mailing address

700 SW 8TH ST
MIAMI FL
33130-3311
US

V. Phone/Fax

Practice location:
  • Phone: 305-558-2570
  • Fax:
Mailing address:
  • Phone: 305-858-0887
  • Fax: 305-854-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAFAEL IGLESIAS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 305-858-0887