Healthcare Provider Details

I. General information

NPI: 1073945713
Provider Name (Legal Business Name): ODOROSOMI MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 E 4TH AVE STE 6
HIALEAH FL
33013-3099
US

IV. Provider business mailing address

3300 E 4TH AVE STE 6
HIALEAH FL
33013-3099
US

V. Phone/Fax

Practice location:
  • Phone: 305-362-2527
  • Fax: 305-362-2530
Mailing address:
  • Phone: 305-362-2527
  • Fax: 305-362-2530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: REYES E LUIS
Title or Position: PRESIDENT
Credential:
Phone: 305-362-2527