Healthcare Provider Details

I. General information

NPI: 1780873380
Provider Name (Legal Business Name): HEALING MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5931 NW 173RD DR UNIT-7A
HIALEAH FL
33015-5106
US

IV. Provider business mailing address

5931 NW 173RD DR UNIT-7A
HIALEAH FL
33015-5106
US

V. Phone/Fax

Practice location:
  • Phone: 305-823-4002
  • Fax:
Mailing address:
  • Phone: 305-823-4002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberHCC8057
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SEBNA LEON
Title or Position: PRESIDENT
Credential:
Phone: 305-823-4002